neoplastic pericarditis
Introduction
Introduction to neoplastic pericarditis Neoplastic periculitis (neoplastic pericarditis) is caused by malignant tumor pericardial metastasis or primary pericardial tumor, such as mesothelioma. Reported lung cancer, breast cancer, leukemia, Hodgkin's disease and non-Hodgkin's lymphoma accounted for 80%. basic knowledge Sickness ratio: 0.0012% Susceptible people: no specific population Mode of infection: non-infectious Complications: constrictive pericarditis
Cause
Causes of neoplastic pericarditis
(1) Causes of the disease
1. Primary pericardial tumors Primary pericardial malignancies are rare, with mesothelioma predominating, followed by benign localized fibrosarcoma, malignant fibrosarcoma, angiosarcoma, lipoma and liposarcoma, benign and primary Malignant teratoma, a rare pericardial tumor, occasionally coexisting with congenital diseases such as tuberous sclerosis, secreting catecholamine pheochromocytoma, is also a rare primary pericardial tumor, in some AIDS patients, Because of Kaposi's sarcoma and cardiac lymphoma, the number of cases of pericardial and cardiac malignancies increases, and cardiac tamponade may occur in the early stages of HIV infection. It must be differentiated from suppurative pericarditis and pericardial malignant tumors to rule out these diseases.
2. Pericardial metastasis Tumor cancer metastasis pathways are:
1 mediastinal malignant tumor spreads and attaches to the pericardium.
2 Tumor nodules are deposited in the pericardium by blood or lymphatic dissemination.
3 tumor diffuse infiltration of pericardium.
4 primary pericardial tumor, local infiltration of pericardium, in most cases, the epicardium and myocardium are not involved.
3. Neoplastic pericardial effusion: neoplasmic pericardial effusion appears serous blood, rapid development, can cause acute or subacute cardiac tamponade, pericardial tumors such as sarcoma, mesothelioma and melanoma, can rupture ventricular and pericardial cavity Internal blood vessels, causing acute pericardial dilatation and accidental fatal cardiac tamponade, pericardial thickening and pericardial effusion (exudation-constrictive pericarditis) or tumor growth envelop the entire heart. Forming constrictive pericarditis.
4. Mediastinal tumor complicated with pericardial effusion is not malignant, mediastinal lymphoma and Hodgkin's disease often appear asymptomatic pericardial effusion, these temporary pericardial effusion, presumably may be the result of lymphatic drainage disorder, mediastinal thymoma and original Primary cardiac tumors can also be complicated by temporary pericardial effusion.
(two) pathogenesis
The routes of metastatic cancer involving the pericardium are:
1 malignant mediastinal tumor is widely attached to the pericardium;
2 tumor nodules deposited in the pericardium by blood-borne or lymphatic dissemination;
3 tumor infiltration diffuse pericardium;
4 primary pericardial tumor pericardial local infiltration, most patients with myocardial not tired.
Tumorous pericarditis produces bloody pericardial effusion, and the development is abnormally rapid, causing acute or subacute cardiac tamponade syndrome, pericardial mesothelioma and sarcoma. Melanoma can also erode the blood vessels in the ventricle or pericardium, causing pericardial dilation and rapid death. Heart tamponade.
Prevention
Neoplastic pericarditis prevention
1. Do a good job in the prevention of common tumors is a positive measure to radically reduce the occurrence of tumors. In the prevention of tumors: 1 The etiology of cancer prevention: changing bad habits such as smoking, eating and curing, Moldy food, etc., patients with a family history of cancer should pay special attention to prevention, 2 common tumors should be census, to do 1 to 2 physical examinations per year, to detect tumors early.
2. Early detection, early diagnosis, early treatment of common tumors, prevention of disease progression to late complications are difficult to control.
Complication
Complications of neoplastic pericarditis Complications, constrictive pericarditis
Complications such as cardiac tamponade and constrictive pericarditis are prone to occur.
1. Cardiac tamponade: neoplastic pericarditis often deteriorates rapidly in a few months, the exudate grows rapidly, and a large amount of pericardial effusion; sometimes pericardial tumors such as sarcoma, mesothelioma and melanoma can erode the ventricle and pericardial vessels , causing acute pericardial dilation and acute or subacute pericardial tamponade.
2. Constrictive pericarditis: Tumorous pericarditis can cause pericardial thickening and pericardial effusion or tumor growth to wrap the entire heart, forming a narrowing pericarditis.
Symptom
Tumorous pericarditis symptoms common symptoms jugular vein engorgement bloody exudate pericardial effusion qi pulse chest pain dyspnea pericardial pericardium inflammation
Tumorous pericarditis has no specific symptoms. Some patients have the most prominent symptoms of dyspnea. They can also have chest pain, cough, and liver. Most patients have obvious signs of cardiac tamponade, such as jugular vein engorgement. When the pulse and hypotension are diagnosed, the heart auscultation is far away, and the pericardial friction sound is less heard.
If the patient is known to have malignant tumors and evidence of pericarditis, a large amount of pericardial effusion and rapid growth or bloody exudate, the possibility of neoplastic pericarditis should be suspected, such as the patient without primary malignant tumor and only found blood Pericardial exudate, at the same time can exclude other causes of pericardial exudate, the disease rapidly deteriorates in a few months and the exudate grows rapidly, can take 800 ~ 1000ml every few days (otherwise there is cardiac tamponade), should be suspicious Mesothelioma.
Examine
Tumor pericarditis
Bacterial examination of pericardial fluid, 85% of patients can detect cancer cells or primary cardiac tumor cells, such as mesothelioma cells, transferred from other parts of the body.
1. Chest X-ray: More than 90% have pleural effusion, heart enlargement, mediastinum widening, hilar mass or occasional heart shadow contour is irregular nodules.
2. ECG examination: electrocardiogram showed non-specific changes, tachycardia, ST-T changes, QRS low voltage and occasional atrial fibrillation, some patients' ECG showed sustained tachycardia, early pericarditis ECG performance, when ECG appeared room Ventricular conduction disorders suggest that the tumor has infiltrated the myocardium and cardiac conduction system.
3. Ultrasound examination of the heart: suggesting pericardial effusion, visible irregular mass protruding into the pericardium.
4. CT and magnetic resonance imaging: pericardial effusion and localized masses that protrude into the pericardial cavity.
Diagnosis
Diagnosis and diagnosis of neoplastic pericarditis
Differential diagnosis
Cancer patients with pericarditis are not caused by cancer disease itself, such as pericarditis after radiotherapy, immunosuppressive drugs induce tuberculous or fungal pericarditis, there are a few reports, intravenous chemotherapy drug doxorubicin, soft red Acute pericarditis occurs when themycin is present.
Cardiac tamponade of neoplastic pericarditis must be differentiated from jugular venous engorgement, hepatomegaly, and peripheral edema due to other causes in cancer patients. Important causes of these symptoms include:
1 Doxorubicin myocardial toxicity or the original heart disease, left and right heart dysfunction progressively worse;
2 upper vena cava obstruction;
3 liver tumor portal hypertension;
4 tumor spread to pulmonary microvascular secondary pulmonary hypertension, echocardiography can help detect irregular mass in the pericardial cavity, CT and MR in addition to showing pericardial effusion, but also to understand the location of the tumor and pericardium, mediastinum and lung The relationship between.
Pericardial puncture and cardiac catheterization: Echocardiography found that a large number of pericardial effusions with suspected cardiac tamponade in cancer patients, using pericardial puncture indwelling catheters at the same time, can identify:
1 superior vena cava obstruction, may coexist with neoplastic pericarditis, cardiac tamponade, facial edema, jugular vein dilatation, cardiac catheter can also help distinguish;
2 cyanosis, hypoxemia and pulmonary vascular resistance are not necessarily the characteristics of cardiac tamponade. After pericardial puncture, the patient's hypoxemia and persistent dyspnea still exist, strongly supporting pulmonary microvascular tumors (neoplastic) Lymphitis and lung dissemination), blood samples taken at the right heart catheterized pulmonary capillary incarceration, cytological examination can obtain evidence of diagnosis.
Because the appearance of pericardial effusion can not distinguish the cause of pericarditis is neoplastic, radioactive or specific cause, the need for fine pericardial effusion cytology identification, cytological results can provide a basis for diagnosis of 85% of malignant pericarditis. Cancerous pericarditis, false negative cytology is not common, but does not contain lymphoma and mesothelioma. For those suspected of having tumorous pericarditis, pericardial effusion should include carcinoembryonic antigen to improve the positive rate of diagnosis, if the cells Negative test results may require a happy bag for biopsy. The specimens for pericardial biopsy should be large enough to provide a histological diagnosis for more than 90% of cases. If the specimen is too small, there may be a false negative diagnosis. For critically ill patients, there is a happy biopsy. Certainly dangerous, it is worth noting that percutaneous transluminal percutaneous endoscopic biopsy is a new method of interventional examination that can be used in patients with suspected pericardial tumors.
