Effusive-constrictive hemodynamic pattern due to neoplastic involvement of the pericardium |
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Authors: | T Mann B R Brodie W Grossman L McLaurin |
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Institution: | 1. From the Departments of Medicine, Harvard Medical School and Peter Bent Brigham Hospital, Boston, Massachusetts USA;2. From the University of North Carolina School of Medicine, Chapel Hill, North Carolina USA |
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Abstract: | Eight patients with metastatic malignancy of the pericardium who demonstrated the hemodynamics of subacute effusive-constrictive pericarditis were studied. All patients had clinical evidence of cardiac tamponade due to malignant pericardial effusion and were referred for therapeutic pericardiocentesis. In six in whom pericardiocentesis was successfully performed, right atrial pressure remained elevated after pericardiocentesis and return of the intrapericardial pressure to zero; in these patients, hemodynamic data were initially compatible with tamponade but suggested constriction after removal of the pericardial fluid. In the remaining two patients, echocardiography revealed pericardial fluid, but attempted pericardiocentesis was unsuccessful. In these two patients, the hemodynamic data suggested pericardial constriction; subsequent pathologic examination revealed neoplastic involvement of the visceral pericardium. Thus, subacute effusive-constrictive pericarditis, previously recognized as a complication of tuberculosis or mediastinal radiation, may also be due to metastatic malignancy. The syndrome can readily be demonstrated when right heart catheterization is performed in conjunction with pericardiocentesis. |
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Keywords: | Present address and address for reprints: Tift Mann MD Raleigh Internal Medicine Associates P A P O Box 18 700 1212 Cedarhurst Drive Raleigh North Carolina 27609 |
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