Malignant Pericardial Disease

  • Caroline Chiles
  • Girish Shroff


Metastases to the pericardium are far more common than primary tumors. Tumor may involve the pericardium by one of three pathways: retrograde lymphatic extension, hematogenous spread, or direct contiguous extension. The predominant route is retrograde spread through lymphatic channels in the mediastinum to the heart, producing small tumor implants on the epicardial surface of the heart. For most cancers, involvement of the pericardium indicates distant metastases, or M1 disease. The presence of a malignant pericardial effusion is associated with a poor prognosis, with survival times less than a year in most cases. The clinical presentation of malignant pericardial effusion is variable, with the majority of patients presenting with gradual onset of dyspnea and chest pain rather than with the acute onset of tamponade. Malignant tamponade implies a poor prognosis with a median survival of 150 days. In a patient with a known malignancy, the finding of a pericardial effusion should prompt further investigation. The pericardial effusion may be related to previous treatment, including both radiation therapy and chemotherapy, infection or inflammation, or may occur as a result of local invasion, hematogenous or lymphatic spread of tumor. Relief of symptoms may be achieved through pericardiocentesis, or creation of a pericardial window. A combination of local and systemic therapy may offer a survival benefit in some patients.


Pericardial Effusion Malignant Pleural Mesothelioma Constrictive Pericarditis Thymic Carcinoma Primary Effusion Lymphoma 
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Copyright information

© Springer Science+Business Media Dordrecht 2012

Authors and Affiliations

  1. 1.Department of RadiologyWake Forest University Health Sciences, Medical Center BoulevardWinston-SalemUSA
  2. 2.Department of RadiologyUniversity of Texas-HoustonHoustonUSA

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