The spread of metastatic
cancer to the pericardium is the most common cause of
cardiac tamponade in medical inpatient settings.
Lung cancer,
breast cancer, and the
hematologic malignancies account for some three quarters of the cases. Occasionally, usually in
lung cancer, the pericardial involvement is the first clinical presentation of the neoplastic disease. Differential diagnosis includes radiation
pericarditis and
cardiac toxicity from chemotherapeutic drugs, as well as any of the causes of pericardial disease in patients without
neoplasm. Idiopathic nonneoplastic, noninflammatory
pericardial effusion is surprisingly common in
cancer patients. The initial
cardiac tamponade may be managed with either needle tap or subxiphoid
pericardiostomy. Pericardiocentesis, performed with echocardiographic guidance and followed by percutaneous
catheter drainage for several days, is safe and effective in neoplastic
pericardial effusion. It may be the only local
therapy that is needed. Further local treatment, for those patients who develop recurrent
cardiac tamponade after an initial drainage procedure, may include
tetracycline sclerosis of the pericardial space, instillation of
cancer chemotherapeutic agents,
radiation therapy, and
pericardiectomy. No controlled clinical trials of these methods of treatment are available. The choice of
therapy is based on various considerations in individual patients, particularly the patient's general condition and the likelihood of a long-term response to treatment of the systemic neoplastic disease.