폐 선암의 첫 증상으로 발생한 악성 심장막 삼출액으로 인한 심장눌림증 1례

Abstract

Pericardial tamponade is a life-threatening condition, as accumulated fluid in the pericardial sac can ultimately lead to fatal shock. The clinical identification of cardiac tamponade can be difficult to determine. Accurate diagnosis and prompt intervention are important to prevent adverse outcomes. Unexplained hypotension, enlarged cardiac silhouette, chest pain or dyspnea in a patient with underlying comorbidities, such as cancer, uremia or trauma history, constitute a high-risk population for pericardial effusions. The identifying cause of pericardial effusion and the understanding of the disease process are also important to prevent recurrent pericardial effusions. We report a case of malignant pericardial effusion with tamponade as an initial presentation in a patient with lung adenocarcinoma. The patient had typical features of tamponade such as neck vein distension, hypotension, tachycardia, tachypnea, muffled heart sound and cardiomegaly on chest X-ray. The pericardial effusion was confirmed by bedside echocardiography. Subsequently, ultrasound guided pericardiocentesis was performed and malignant cells were detected in the effusion by cytology. Eventually, lung adenocarcinoma was detected by CT-guided tissue biopsy. Hemodynamic changes, associated underlying causes, clinical presentations, radiologic findings, and the emergency management of cardiac tamponade were reviewed with the current literature.