Ewha Med J.  2017 Apr;40(2):91-93. 10.12771/emj.2017.40.2.91.

Early Detection of Hidden Adenocarcinoma through the Prompt Pericardiocentesis in Patient with Small Pericardial Effusion

• Shinebayar B
• Gill SY
• Jeong H
• Choi KC
• Hong J
• Park SM

• KMID: 2379504
• DOI: http://doi.org/10.12771/emj.2017.40.2.91

Abstract

Pericardial drainage is an important diagnostic and therapeutic option in the symptomatic patient with large amount of pericardial effusion (PE). However, when the amount of PE is relatively small, physicians are often reluctant to perform the invasive drainage of the fluid due to the increased risk of causing myocardial injury during the procedure. Even in some cases of suspected pericarditis with small amount PE, an initial empirical anti-inflammatory therapy is often recommended. A 65-year-old woman presented with mild dyspnea for two weeks. The echocardiography revealed small amount of PE. A careful fluoroscopy-guided pericardiocentesis, subsequent pericardial fluid cytology, and thorough whole body check-up demonstrated adenocarcinoma with no proven primary site. After the palliative chemotherapy, she had survived for 15 months until her death due to asphyxia. Although pericardiocentesis is considered dangerous in small amount of PE, a prompt and careful drainage may provide early detection of hidden malignancy and better survival outcome.

Keyword

Pericardial effusion; Adenocarcinoma; Pericardiocentesis

MeSH Terms

Adenocarcinoma*
Aged
Asphyxia
Drainage
Drug Therapy
Dyspnea
Echocardiography
Female
Humans
Pericardial Effusion*
Pericardial Fluid
Pericardiocentesis*
Pericarditis

Figure

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  Fig. 1 Echocardiography before and after pericardiocentesis and histologic finding. (A) Echocardiography shows small pericardial effusion (PE, yellow arrow heads) as the initial presentation of unrecognized adenocarcinoma of unknown primary origin before pericardiocentesis. (B). Follow-up echocardiography after prompt pericardiocentesis shows minimal PE. (C) Mucicarmine stain of cell block of pericardial fluid shows atypical cells having varying-sized nuclei with vacuolar cytoplasm and predominant nucleoli (eccentric nuclei like signet ring cells, blue arrows), focally arranged in tubule formation (indicating adenocarcinoma).

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