Cardiac tamponade secondary to metastatic non-small cell lung cancer: an unusual presentation with peripheral arterial ischemia. Case report and literature review.

• DOI: https://doi.org/10.22533/at.ed.01596526160413

• Palavras-chave: cardiac tamponade, malignant pericardial effusion, non-small cell lung cancer, acute arterial ischemia, pericardiocentesis, cancer-associated thrombophilia, electrical alternans.

• Keywords: cardiac tamponade, malignant pericardial effusion, non-small cell lung cancer, acute arterial ischemia, pericardiocentesis, cancer-associated thrombophilia, electrical alternans.

• Abstract:

  Cardiac tamponade due to malignant pericardial effusion is a life-threatening oncological emergency requiring immediate intervention. We present the case of a 54-year-old man who presented with chest pain, dyspnea, and signs of low cardiac output. Two months prior, he had suffered an episode of acute lower extremity arterial ischemia, which was managed with anticoagulation. Clinical echocardiography showed moderate-to-severe pericardial effusion with right ventricular collapse, and the electrocardiogram revealed electrical alternans and low voltage. Urgent pericardiocentesis drained 810 mL of bloody fluid with cytology positive for non-small cell lung adenocarcinoma. After a brief improvement, the patient died one month later despite chemotherapy. The mechanisms linking cancer-associated thrombophilia to arterial and pericardial events are discussed; the epidemiology of neoplastic pericardial effusion is reviewed; and diagnostic and therapeutic strategies are updated. This case underscores the importance of considering underlying malignancy in the presence of cardiac tamponade and an unprovoked arterial event.