Adenocarcinoma of the lung presenting with pericardial tamponade: report of a case and review of the literature.

In a patient with cancer, a diagnosis of cardiac tamponade should be considered when there is dyspnea, cough, thready pulse or pulsus paradoxus, low systolic blood pressure, engorged neck veins, an enlarged cardiac silhouette, and total or ventricular electrical alternans. Immediate pericardiocentesis is indicated in such patients to avoid the risk of sudden death. A pericardial window should be created for more prolonged palliation of cardiac tamponade. Cytologic examination of the pericardial fluid often reveals malignant or highly suspect cells. Metastatic carcinomas from the lung and breast are the most common tumors that involve the heart when they spread in a retrograde fashion through the cardiac lymphatic system. Total pericardiectomy for the treatment of cardiac tamponade that is due to cancer is not generally advisable. Radiation therapy in the cardiac area with or without systemic chemotherapy is effective in decreasing the amount and the recurrence of neoplastic pericardial effusion.