“A double twist” presentation – a case report of purulent cardiac tamponade following a rare complication of small-cell lung cancer radiotherapy
  • Diana Amorim
    Pulmonology Department, Local Health Unit of the Leiria Region - E.P.E., Leiria, Portugal
  • Carolina Miguel Gonçalves
    Cardiology Department, Local Health Unit of the Leiria Region - E.P.E., Leiria, Portugal
  • Margarida Cabral
    Cardiology Department, Local Health Unit of the Leiria Region - E.P.E., Leiria, Portugal
  • Sónia Silva
    Pulmonology Department, Local Health Unit of the Leiria Region - E.P.E., Leiria, Portugal; ciTechCare – Center for Innovative Care and Health Technology, Polytechnique of Leiria, Leiria, Portugal
  • Fátima Saraiva
    Cardiology Department, Local Health Unit of the Leiria Region - E.P.E., Leiria, Portugal
  • João Morais
    Cardiology Department, Local Health Unit of the Leiria Region - E.P.E., Leiria, Portugal; ciTechCare – Center for Innovative Care and Health Technology, Polytechnique of Leiria, Leiria, Portugal
  • Salvato Feijó
    Pulmonology Department, Local Health Unit of the Leiria Region - E.P.E., Leiria, Portugal

Keywords

Small cell lung cancer, STEMI, cardiac tamponade, differential diagnosis, radiotherapy

Abstract

Background: Small cell lung cancer is an aggressive tumor with a poor prognosis that requires prompt treatment. While radiotherapy may enhance survival when superior vena cava syndrome is present, radiation therapy–induced pericardial disease can be a potential complication.
Case Report: A 55-year-old man, who recently underwent radiotherapy for stage IV small-cell lung cancer complicated by superior vena cava syndrome, presented with chest pain and dyspnea. In the emergency room, he was dyspneic, hypotensive, and tachycardic. Pulmonary auscultation revealed the absence of lung sounds on the right. The initial electrocardiogram showed ST-segment elevation in lateral leads and in lead DII, with reciprocal changes in lead DIII. A bedside transthoracic echocardiogram revealed cardiac tamponade and emergent pericardiocentesis was performed, removing 500 ml of purulent fluid, resulting in an immediate clinical improvement. Thoracentesis was also performed, showing no empyema. Large spectrum empirical antibiotic therapy was started. Cultures from the pericardial fluid and peripheral blood grew multi-sensitive Streptococcus pneumoniae. Cytological analysis of the pericardial fluid was consistent with infection. The patient improved after 2 weeks of targeted antibiotic therapy and underwent the first cycle of chemotherapy. He was discharged with an early scheduled pulmonology appointment.
Conclusions: Although the most common causes of pericardial effusion in lung cancer are malignant, non-malignant etiologies should also be considered. This patient had an infectious pericardial effusion most probably due to a pericardial-mediastinal mass fistula caused by radiotherapy. This was a diagnostic challenge, both in the emergency room as well in the inpatient setting.

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    Published: 2024-04-23
    Issue: 2024: Vol 11 No 6 (view)


    How to cite:
    1.
    Amorim D, Miguel Gonçalves C, Cabral M, Silva S, Saraiva F, Morais J, Feijó S. “A double twist” presentation – a case report of purulent cardiac tamponade following a rare complication of small-cell lung cancer radiotherapy. EJCRIM 2024;11 doi:10.12890/2024_004477.

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