Pericardial metastases

Introduction to pericardial metastases Pericardial metastases are the result of metastasis of other parts of the malignant tumor to the pericardium and are one of the systemic manifestations of malignant tumors. Pericardial metastases are more common than primary pericardial tumors and cardiac metastases. Autopsy confirmed that 5% to 15% of patients with malignant tumors had pericardial involvement. basic knowledge The proportion of illness: 0.002% Susceptible people: no specific population Mode of infection: non-infectious Complications: arrhythmia

Pericardial metastasis

Primary disease metastasis (35%):

80% of the primary lesions of pericardial metastases are primary bronchial carcinoma, breast cancer, leukemia, Hodgkin's disease and non-Hodgkin's lymphoma. Less common are gastrointestinal tumors, ovarian cancer, cervical cancer, sarcoma, Thymic cancer and melanoma.

Pathological changes (20%):

The main pathological process is tumor invasion and pericardium leading to bloody or serous exudation. It develops extremely rapidly and can produce acute or subacute cardiac tamponade. Pericardial metastases from sarcoma and melanoma can invade the ventricles and pericardial vessels. , resulting in acute pericardial dilatation and fatal pericardial tamponade, pericardial thickening and pericardial effusion can coexist or exist alone, similar to the pathological changes of exudative-constrictive pericarditis or constrictive pericarditis.

Pericardial tumor infiltration (10%):

Primary pericardial tumor pericardial local infiltration.

Pathogenesis

The formation of pericardial metastases is achieved by the following pathways:

1. Malignant mediastinal tumors are widely attached to the pericardium.

2. Tumor nodules are deposited in the pericardium by blood or lymphatic dissemination.

3, tumor infiltration diffuse pericardium.

Pericardial metastases prevention

Treatment of primary tumors and early detection and treatment of tumor pericardial metastasis is the key to preventing pericardial metastases. Through regular physical examinations, abnormalities in the body and risk factors for cancer are discovered, and the risk of malignant tumors is reduced by timely adjustment and treatment. On the other hand, regular physical examination can achieve early detection, early diagnosis, early treatment, ie secondary prevention. Try not to drink alcohol.

Pericardial metastases complications Complications arrhythmia

There may be complications such as arrhythmia and pericardial tamponade.

Symptoms of pericardial metastases Common symptoms Chest pain mediastinum widening odd pulse pericardial effusion jugular vein anger stagnation sitting respiratory pericardial filling pericarditis dyspnea tachycardia

1. Pericardial metastases mainly cause acute exudative pericarditis, but they are usually asymptomatic, most of which are only found by chance in autopsy. However, it is one of the common causes of acute pericarditis in developed countries. In patients with undiagnosed malignant tumors, leukemia, etc., tamponade may be the earliest manifestation.

2, breathing difficulties are the most common symptoms.

3, other common symptoms and signs chest pain, cough, sitting breathing, liver enlargement, and heart sounds distant and pericardial friction sounds are rare, most patients with pericardial metastases only appear in obvious pericardial tamponade such as jugular vein engorgement, odd pulse and low Blood pressure is diagnosed.

In patients with pericarditis, 90% of chest X-ray examinations are abnormal, manifested as pleural effusion, enlarged heart, widened mediastinum, enlarged hilar, etc., a few manifestations of irregular nodules on the edge of the heart, electrocardiogram manifested as pericarditis Non-specific changes, such as tachycardia, ST-T wave changes, QRS low voltage, and occasional atrial fibrillation, in rare cases, persistent tachycardia and ECG changes may be the earliest manifestations.

A large number of metastatic pericardial tumors were found at autopsy; early clinical manifestations were easily masked by the primary disease, and typical symptoms were pericardial effusion and pericardial tamponade.

Examination of pericardial metastases

1. Cytological examination: Finding tumor cells in the pericardial puncture fluid is meaningful for diagnosis.

2. Serum carcinoembryonic antigen (CEA) is increased.

3, X-ray examination: may show heart enlargement, pericardial effusion signs; teratoma tumors can be seen on the chest radiograph.

4, pericardial cavity inflation (CO2) contrast angiography: may show the contour of the pericardial mass.

5, cardiovascular angiography: may show localized extracardiac compression zone.

6, echocardiography: echocardiography has been widely used in the diagnosis of pericardial disease, can be found in substantial tumors and pericardial effusion, especially sensitive to pericardial effusion.

7. CT examination: The initial CT scan was affected by biological movements. The modern CT examination device overcomes the above factors and significantly increases the useful information. Although biological movement may still affect the diagnosis of the heart chamber, However, the diagnosis of the pericardial site has been quite correct.

8, magnetic resonance examination: the main advantage of magnetic resonance examination is that it can scan any plane, provide images of the heart, large blood vessels and pericardium, without the influence of radiation or intravenous contrast agents, through the magnetic relaxation time to the tissue The potential resolution of features is superior to CT and echocardiography, but whether it is CT or magnetic resonance, it is difficult to characterize the tissue. Overall, magnetic resonance is superior to CT in localization or qualitative ability.

9, mediastinoscopy and biopsy sampling pathology: is an effective means to achieve local visual and pathological diagnosis, but endoscopy has its limitations, the situation of the observation of local and external contact is limited, still need to combine other Auxiliary inspection.

10. Electrocardiogram examination: ECG signs of malignant pericardial exudate and pericardial tamponade, visible low voltage, sinus tachycardia, various changes of T wave, lack of specificity of low voltage of electrocardiogram, and low sensitivity during pericardial effusion Rinken beiger RL et al reported that when a large amount of pericardial effusion or pericardial tamponade, the electrocardiogram may have a more specific sign, that is, electrical alternation. In electrocardiography, every 2 or 3 heartbeats, P wave The pattern changes with RST wave, complete electrocardiogram alternation, including the alternating phenomenon of atrial and ventricular complex waves. It is only seen in pericardial tamponade. The mechanism of electrocardiogram alternation in pericardial effusion is that the heart is suspended in liquid medium to make the heart have Extraordinary large swing, P wave and R wave are high when the heart is closer to the chest wall. When the heart moves backward, the amplitude of P wave and R wave decreases. The common arrhythmia of pericardial effusion is atrial flutter, atrial fibrillation, Multifocal atrial tachycardia, as well as non-sustained, sudden paroxysmal atrial tachycardia.

Diagnosis and differentiation of pericardial metastases

A comprehensive and comprehensive evaluation is required to make a definitive diagnosis, mainly based on the manifestations of pericardial inflammation and evidence of primary tumor metastasis to the pericardium. Clinical symptoms, signs, and chest X-rays can provide clues to pericardial effusion. Echocardiography is clear. The most simple and effective method for pericardial effusion, CT and magnetic resonance imaging in addition to clear pericardial effusion can also diagnose the proximal mediastinum and primary tumor of the lung. For patients with pericardial effusion, 85% can be pumped through pericardium Liquid cytology is a clear diagnosis, false negative is not common, mainly seen in lymphoma, but multiple examinations can increase the positive rate, detection of carcinoembryonic antigen (CEA) can also provide further diagnostic basis, in the case of negative test above can be considered Pericardial biopsy, if adequately taken, can determine the cause of diagnosis for more than 90% of patients.

Differential diagnosis

It should be noted that about half of patients with symptomatic pericarditis have a pericarditis that is not caused by metastasis of malignant tumors. Instead, due to radiotherapy or spontaneous causes, many cancer patients have low immune function and/or treatment during the disease. The cause is susceptible to tuberculous and fungal pericarditis, and a small number of patients can cause acute pericarditis when receiving systemic chemotherapy (such as doxorubicin, daunorubicin).

The relationship between neoplastic pericarditis and cardiac compression syndrome needs to be differentiated from other causes of venous congestion:

1 right heart failure caused by basic heart disease or doxorubicin cardiotoxicity;

2 superior vena cava obstruction syndrome;

3 portal hypertension caused by liver tumors;

4 microvascular tumors caused by pulmonary hypertension secondary to pulmonary hypertension, in addition, congenital heart diverticulum, ventricular aneurysm, coronary aneurysm or pericardial lesions in imaging and cardiac pericardial tumors should be noted.

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