Pericardial effusions are not infrequently found in patients with locally advanced or disseminated malignancies and can cause respiratory distress. In the presence of a malignant pleural effusion (MPE), a pericardial effusion may not be apparent or suspected until the MPE has been successfully treated. The purpose of this investigation was to identify the frequency of significant pericardial effusions in patients referred for the treatment of MPE and to determine whether their recognition would alter the management of MPE.
Patients referred for the treatment of a symptomatic MPE were prospectively evaluated for the presence of a pericardial effusion by transthoracic (TTE) echocardiogram prior to any definitive therapy. Patients whose TTE was equivocal or technically difficult also underwent computed tomographic imaging (CT) of the chest.
Seventy patients referred for the treatment of MPE underwent a TTE. Twenty one of these patients also required a CT of the chest. The incidence of a significant pericardial effusion varied by primary malignancy (hematologic 4/9 [44%], lung 7/27 [26%], breast 4/17 [24%], unknown primary 1/6 [16%], other 2), side of the MPE (left 9/28 [32%], right 6/31 [19%], bilateral 3/11 [27%]), and whether the patient had received previous systemic (4/54 [7%]) or radiation (9/36 [25%]) therapy. The cytology examination of pericardial effusions identified in this investigation found evidence of malignant cells in 13 of 16 patients sampled. The detection of a significant pericardial effusion changed the intended therapy in 16 of 18 [88%] patients with MPE.
Occult yet significant pericardial effusions are not infrequently associated with MPE and most commonly also represent metastatic disease. Their incidence varies by the primary malignancy, MPE location and patient treatment history. The presence of a significant pericardial effusion frequently changes the management of a patient with MPE.
Patients with a symptomatic MPE should be evaluated for a concomitant pericardial effusion prior to any definitive therapy as their management will frequently change.
R.K. Freeman, None.