Malignant pericardial effusion is a common and serious manifestation in malignancies. The origins of the malignant process include solid tumors or hematological malignancies, while primary neoplasms of the pericardium are less common. In the oncological patient, pericardial effusion may develop by several different mechanisms, namely by direct or metastatic spread of the primary process or as a complication of antineoplastic therapies. In some cases, pericardial effusion may be the first manifestation of the disease, and that is why malignancy must be excluded in every case of an acute pericardial disease with cardiac tamponade at presentation, rapidly increasing pericardial effusion and an incessant or recurrent course. Thus, the definite differentiation of malignant pericardial effusion and rapid diagnosis are of particular therapeutic and prognostic importance. Management of these patients is multidisciplinary and requires team work, but at present there is a need for further research. An individual treatment plan should be established, taking into account cancer stage, the patient's prognosis, local availability and experience. In emergency cases with cardiac tamponade or significant effusion, initial relief can be obtained with pericardiocentesis. Despite the magnitude of this serious problem, little progress has been made in the treatment of pericardial effusion secondary to malignant disease.

Halfdanarson TR, Hogan WJ, Moynihan TJ: Oncologic emergencies: diagnosis and treatment. Mayo Clin Proc 2006;81:835-848.
Kim SH, Kwak MH, Park S, Kim HJ, Lee HS, Kim MS, Lee JM, Zo JI, Ro JS, Lee JS: Clinical characteristics of malignant pericardial effusion associated with recurrence and survival. Cancer Res Treat 2010;42:210-216
Karatolios K, Alter P, Maisch B: Differentiation of malignant from nonmalignant, inflammatory pericardial effusions with biomarkers. Herz 2009;34:624-633.
Jeong TD, Jang S, Park CJ, Chi HS: Prognostic relevance of pericardial effusion in patients with malignant diseases. Korean J Hematol 2012;47:237-238.
Refaat M, Katz W: Neoplastic pericardial effusion. Clin Cardiol 2011;34:593-598.
Galderisi M, Marra F, Esposito R, Lomoriello V, Pardo M, de Divitiis O: Cancer therapy and cardiotoxicity: the need of serial Doppler echocardiography. Cardiovasc Ultrasound 2007;5:4.
Braverman AC, Antin JH, Plappert MT, Cook EF, Lee RT: Cyclophosphamide cardiotoxicity in bone marrow transplantation: a prospective evaluation of new dosing regimens. J Clin Oncol 1991;9:1215-1223.
Dow E, Schulman H, Agura E: Cyclophosphamide cardiac injury mimicking acute myocardial infarction. Bone Marrow Transplant 1993;12:169-172.
Gottdiener JS, Appelbaum FR, Ferrans VJ, Deisseroth A, Ziegler J: Cardiotoxicity associated with high-dose cyclophosphamide therapy. Arch Intern Med 1981;141:758-763.
Frankel SR, Eardley A, Lauwers G, Weiss M, Warrell RP Jr: The ‘retinoic acid syndrome' in acute promyelocytic leukemia. Ann Intern Med 1992;117:292-296.
Soignet SL: Clinical experience of arsenic trioxide in relapsed acute promyelocytic leukemia. Oncologist 2001;6(suppl 2):11-16.
Kantarjian H, Sawyers C, Hochhaus A, Guilhot F, Schiffer C, Gambacorti-Passerini C, Niederwieser D, Resta D, Capdeville R, Zoellner U, Talpaz M, Druker B, Goldman J, O'Brien SG, Russell N, Fischer T, Ottmann O, Cony-Makhoul P, Facon T, Stone R, Miller C, Tallman M, Brown R, Schuster M, Loughran T, Gratwohl A, Mandelli F, Saglio G, Lazzarino M, Russo D, Baccarani M, Morra E; International STI571 CML Study Group: Hematologic and cytogenetic responses to imatinib mesylate in chronic myelogenous leukemia. N Engl J Med 2002;346:645-652.
Bomford CK, Kunkler IH (eds): Walter and Miller's Textbook of Radiotherapy: Radiation Physics, Therapy and Oncology. Edinburgh, Churchill Livingstone, 2002.
Perrault DJ, Levy M, Herman JD, Burns RJ, Bar Shlomo BZ, Druck MN, Wu WQ, McLaughlin PR, Gilbert BW: Echocardiographic abnormalities following cardiac radiation. J Clin Oncol 1985;3:546-551.
Pohjola-Sintonen S, Totterman KJ, Salmo M, Siltanen P: Late cardiac effects of mediastinal radiotherapy in patients with Hodgkin's disease. Cancer 1987;60:31-37.
Imazio M, Mayosi B, Brucato A, Markerl G, Trinchero R, Spodick D, Adler Y: Triage and management of pericardial effusion. J Cardiovasc Med 2010;11:928-935.
Jneid H, Maree AO, Palacios I: Pericardial tamponade: clinical presentation, diagnosis and catheter-based therapies; in Parrillo JE, Dellinger RP (eds): Critical Care Medicine: Principles of Diagnosis & Management in the Adult, ed 3. Philadelphia, Mosby, 2007.
D'Cruz I, Rehman AU, Hancock HL: Quantitative echocardiographic assessment in pericardial disease. Echocardiography 1997;14:207-214.
Verhaert D, Gabriel R, Johnston D, Lytle B, Desai M, Klein A: The role of multimodality imaging in the management of pericardial disease. Circ Cardiovasc Imaging 2010;3:333-343.
Rajiah P: Cardiac MRI. 2. Pericardial diseases. AJR Am J Roentgenol 2011;197:W621-W634.
Talreja DR, Nishimura RA, Oh JK, Holmes DR: Constrictive pericarditis in the modern era: novel criteria for diagnosis in the cardiac catheterization laboratory. J Am Coll Cardiol 2008;51:315-319.
Kraft A, Weindel K, Ochs A, Marth C, Zmija J, Schumacher P, Unger C, Marmé D, Gastl G: Vascular endothelial growth factor in the sera and effusions of patients with malignant and nonmalignant disease. Cancer 1999;85:178-187.
Maisch B, Ristic A, Pankuweit S: Evaluation and management of pericardial effusion in patients with neoplastic disease. Prog Cardiovasc Dis 2010;53:157-163.
Karatolios K, Maisch B, Pankuweit S: Tumor markers in the assessment of malignant and benign pericardial effusion. Herz 2011;36:290-295.
Karatolios K, Pankuweit S, Moosdorf RG, Maisch B: Vascular endothelial growth factor in malignant and benign pericardial effusion. Clin Cardiol 2012;35:377-381.
Takahashi H, Shibuya M: The vascular endothelial growth factor (VEGF)/VEGF receptor system and its role under physiological and pathological conditions. Clin Sci (Lond) 2005;109:227-241.
Brown LF, Berse B, Jackman RW, Tognazzi K, Guidi AJ, Dvorak HF, Senger DR, Connolly JL, Schnitt SJ: Expression of vascular permeability factor (vascular endothelial growth factor) and its receptors in breast cancer. Hum Pathol 1995;26:86-91.
Brown LF, Berse B, Jackman RW, Tognazzi K, Manseau EJ, Dvorak HF, Senger DR: Increased expression of vascular permeability factor (vascular endothelial growth factor) and its receptors in kidney and bladder carcinomas. Am J Pathol 1993;143:1255-1262.
Karatolios K, Pankuweit S, Maisch B: Diagnostic value of biochemical biomarkers in malignant and non-malignant pericardial effusion. Heart Fail Rev 2012, E-pub ahead of print.
Ristic AD, Pankuweit S, Maksimović R, Moosdorf R, Maisch B: Pericardial cytokines in neoplastic, autoreactive, and viral pericarditis. Heart Fail Rev 2012, E-pub ahead of print.
Imazio M, Brucato A, Myosi B, Derosa F. G, Lestuzzi C, Macor A, Trinchero R, Spodick D, Adler Y: Medical therapy of pericardial disease. II. Noninfectious pericarditis, pericardia effusion and contrictive pericarditis. J Cardiovasc Med (Hagerstown) 2010;11:785-794.
Atar S, Chiu J, Forrester J, Siegel R: Bloody pericardial effusion in patients with cardiac tamponade. Chest 1999;116:1564-1569.
Tsang TS, Enriquez-Sarano M, Freeman WK, Barnes ME, Sinak LJ, Gersh BJ, Bailey KR, Seward JB: Consecutive 1127 therapeutic echocardiographically guided pericardiocenteses: clinical profile, practice patterns, and outcomes spanning 21 years. Mayo Clin Proc 2002;77:429-436.
Gornik H, Gerhard-Herman M, Beckman J: Abnormal cytology predicts poor prognosis in cancer patients with pericardial effusion. J Clin Oncol 2005;23:5211-5216.
Imazio M, Brucato A, Cumetti D, Brambilla G, Demichelis B, Ferro S, Maestroni S, Cecchi E, Belli R, Palmieri G, Trinchero R: Corticosteroids for recurrent pericarditis: high versus low doses: a nonrandomized observation. Circulation 2008;118:667-671.
Levy PY, Moatti JP, Gauduchon V, Vandenesch F, Habib G, Raoult D: Comparison of intuitive versus systematic strategies for aetiological diagnosis of pericardial effusion. Scand J Infect Dis 2005;37:216-220.
Levy PY, Fournier PE, Charrel R, Metras D, Habib G, Raoult D: Molecular analysis of pericardial fluid: a 7-year experience. Eur Heart J 2006;27:1942-1946.
Kunitoh H, Tamura T, Shibata T, Imai M, Nishiwaki Y, Nishio M, Yokoyama A, Watanabe K, Noda K, Saijo N: A randomized trial of intrapericardial bleomycin for malignant pericardial effusion with lung cancer. Br J Cancer 2009;100:464-469.
Van der Gaast A, Kok TC, van der Linden NH, Splinter TA: Intrapericardial instillation of bleomycin in the management of malignant pericardial effusion. Eur J Cancer Clin Oncol 1989;25:1505-1506.
Lestuzzi C, Lafaras C, Bearz A, Gralec R, Viel E, Buonadonna A, Bischiniotis T: Malignant pericardial effusion: sclerotherapy or local chemotherapy? Br J Cancer 2009;101:734-735.
Imazio M, Cecchi E, Demichelis B, Ierna S, Demarie D, Ghisio A, Pomari F, Coda L, Belli R, Trinchero R: Indicators of poor prognosis of acute pericarditis. Circulation 2007;115:2739-2744.
Maisch B, Seferovic PM, Ristic AD, Erbel R, Rienmuller R, Adler Y, Tomkowski WZ, Thiene G, Yacoub MH; Task Force on the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology: Guidelines on the diagnosis and management of pericardial diseases executive summary. Eur Heart J 2004;25:587-610.
Dempke W, Firusian N: Treatment of malignant pericardial effusion with 32P-colloid. Br J Cancer 1999;80:1955-1957.
Martini N, Freiman AH, Watson RC, Hilaris BS: Intrapericardial installation of radioactive chromic phosphate in malignant effusion. Am J Roentgenol 1977;128:639-664.
Lestuzzi C, Bearz A, Lafaras C, Gralec R, Cervesato E, Tomkowski W, DeBiasio M, Viel E, Bishiniotis T, Platogiannis DN, Buonadonna A, Tartuferi L, Piazza R, Tumolo S, Berretta M, Santini F, Imazio M: Neoplastic pericardial disease in lung cancer: impact on outcomes of different treatment strategies. A multicenter study. Lung Cancer 2011;72:340-347.
Mann T, Brodie BR, Grossman W, McLaurin L: Effusive-constrictive hemodynamic pattern due to neoplastic involvement of the pericardium. Am J Cardiol 1978;41:781-786.
Tsang TS, Seward JB, Barnes ME, Bailey KR, Sinak LJ, Urban LH, Hayes SN: Outcomes of primary and secondary treatment of pericardial effusion in patients with malignancy. Mayo Clin Proc 2000;75:248-253.
García-Riego A, Cuinas C, Vilanova JJ: Malignant pericardial effusion. Acta Cytol 2001;45:561-566.
Dequanter D, Lothaire P, Berghmans T, Sculier JP: Severe pericardial effusion in patients with concurrent malignancy: a retrospective analysis of prognostic factors influencing survival. Ann Surg Oncol 2008;15:3268-3271.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.