Pericardial Effusion as First Manifestation of NSCLC

Clinical Image

Ann Hematol Oncol. 2015;2(5): 1037.

Pericardial Effusion as First Manifestation of NSCLC

Werner JO¹#, Stickel JS¹#*, Droppa M², Krumm P³, Müller MR¹, Kanz L¹ and Kreth F4

¹Department of Medical Oncology, Hematology, Immunology, Rheumatology and Pulmonology, University Hospital of Tuebingen, Germany

²Department of Cardiology and Cardiovascular Medicine, University Hospital of Tuebingen, Germany

³Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Germany

44Department of Gastroenterology, Hepatology, Infectious Diseases and Translational Gastrointestinal Oncology, University Hospital of Tuebingen, Germany #These Authors Contribute Equally to this Work

*Corresponding author: Stickel JS, Department of Medical Oncology, Hematology, Immunology, Rheumatology and Pulmonology, Medical Center II, South West German Comprehensive Cancer Center, University Hospital of Tuebingen, Ottfried-Müller-Straße 10, 72076 Tuebingen, Germany

Received: May 01, 2015; Accepted: May 11, 2015; Published: May 11, 2015

Clinical Image

A 57-year-old man was admitted to the emergency department with progressive dyspnea, hoarseness and cough for four weeks. Past medical history included loss of weight (10 kg within 2-3 months) and nicotine consumption, collectively 40 pack years. Physical examination showed a tachycardic (115/min), normotensive, cachectic and anxious patient using accessory respiratory muscles and signs of superior cava syndrome. Chest radiograph revealed immense cardiomegaly, pleural effusions on both sides and a nodular compaction in the right midfield (Figure 1). Echocardiography detected a ‘swinging heart’ with massive pericardial effusion in transition to a cardiac tamponade (Figure 2), rarely described before in such clinical context [1,2]. Pericardial puncture revealed 2.5l of exudates; histological without malignancy. Bronchoscopy was performed, showing mucosal carcinosis, especially at the right carina of the superior lobe. Cryobiopsy uncovered a high grade bronchial adenocarcinoma without relevant ALK1-EML4-Inversion and wild type of EGFR. Subsequent PET-computerized tomography showed an advanced tumor stage (Figure 3). Due to the pericardial effusion with even dismal prognosis [3,4]. Palliative chemotherapy with cisplatin and pemetrexed was started.