Reporte de un caso con taponamiento cardíaco como forma de presentación de cáncer de pulmón / Report of a Case with Cardiac Tamponade as a Presentation of Lung Cancer

El taponamiento cardíaco es un evento grave que requiere un rápido diagnóstico y tratamiento, sus causas no siempre son evidentes, aunque, los procesos neoplásicos y en particular los de pulmón, deben tenerse siempre en cuenta. El objetivo de este trabajo fue ejemplificar que el taponamiento cardíaco puede ser la forma de manifestación de un cáncer de pulmón. Se presentó un paciente de 58 años de edad, fumador por 45 años, portador de un taponamiento cardíaco, con antecedentes de derrame pericárdico previo y anemia, con disnea de esfuerzo, acompañado de tos seca. Se realizó pericardiotomia, drenando 2 750 ml de líquido serohemático. El proceder quirúrgico confirmó el diagnóstico etiológico de adenocarcinoma mixto moderadamente diferenciado de pulmón bilateral difuso, con metástasis en pericardio visceral y parietal. Las neoplasias producen con frecuencia derrames hemorrágicos o serohemáticos y taponamiento cardíaco, frecuentemente recidivantes tras la pericardiocentesis, como sucedió en este paciente.

The cardiac tamponade is a serious event that requires a quickly diagnose and treatment. Its causes not always are evident, even though, neoplastic processes and in particular the ones related to lungs, should be taken into account. The objective of this work was to provide that the cardiac tamponade could be a way that a lung cancer be manifested. A fifty eight -year- old patient, with a history of smoking for 45 years with a cardiac tamponade, history of previous pericardial stroke, anaemia and hacking cough was presented in this article. A pericardiotomy was performed to drain 2750 millilitres of serohematic fluid. The surgical procedure confirmed the existence of a mixed moderately differentiated, lung adenocarcinoma, with metastasis in the parietal and visceral pericardium. The neoplasia produce frequently hemorrhagic and serohematic bleeding, as well as cardiac tamponade, frequently after pericardiocenthesis, as occurred with this patient.

Análise epidemiológica das pericardiotomias realizadas em um hospital universitário de Curitiba / Epidemiological analysis of pericardiotomys held in a university hospital of Curitiba

OBJETIVO: Analisar epidemiologicamente a utilização da janela pericárdica(JP) no diagnóstico de lesão cardíaca em um hospital universitário de trauma de Curitiba. MÉTODOS: Estudo observacional, retrospectivo, de análise dos prontuários de pacientes que foram submetidos a pericardiotomia por trauma contuso ou penetrante, no período de seis anos, no serviço de Urgência e Emergência do Hospital Universitário Cajuru. RESULTADOS: 120 pacientes foram submetidos à Janela Pericárdica no período acima referido. A faixa etária variou de 15 a 80 anos, sendo a maior prevalência entre os 20 a 30 anos (49,7 por cento), 105(87,5 por cento) pacientes eram homens e 15(12,5 por cento) mulheres. Os traumas fechados foram 14(11,67 por cento) e penetrantes 105(87,5 por cento). Dos penetrantes, 41 foram por ferida de arma branca, 60 por ferida de arma de fogo e quatro por ambas. Quanto à localização das lesões: 47,5 por cento foram precordiais, 34,16 por cento em transição tóraco-abdominal, 5,0 por cento em ambas e 13,33 por cento em outras localizações. Das JP realizadas, 72,5 por cento foram negativas e 27,5 por cento positivas. Dentre as positivas, as lesões cardíacas encontradas foram: átrio direito 21,2 por cento, ventrículo direito 30,3 por cento, ventrículo esquerdo 24,2 por cento, aorta ascendente 3 por cento, nenhuma lesão 21,2 por cento. Houve 35 óbitos: 18 deles até 24hs e 17 após 24hs. CONCLUSÃO: A janela pericárdica foi mais realizada em homens jovens com ferimentos penetrantes por arma de fogo, em sua maioria com lesão do ventrículo direito como principal achado, concordando com a literatura revisada.

OBJECTIVE: Epidemiologically analyze the use of the pericardiostomy in the diagnosis of cardiac injury in a trauma universitary hospital in Curitiba. METHODS: Observacional, retrospective study, analyzing medical records of patients who were submitted to penetrating or blunt trauma, in a period of 06 years, in Urgency and Emergency unit of Cajuru Universitary Hospital. RESULTS: 120 patients had been submitted to pericardiostomy in the period above related. The age group varied from 15 to 80 years, the major prevalence between 20 and 30 years (49.7 percent), 105 patients were men and 15 women. Blunt trauma corresponded to 14 patients and penetrating to 105 patients. From penetrating ones, 41 patients were inflicted by stabwound, 60 by gunshot wound and 4 by both. About injury sites: 47.5 percent had been precordial, 34.16 percent in thoraco-abdominal transistion, 5.0 percent in both and 13.33 percent in other sites. From the accomplished JP, 72.5 percent had been negative and 27.5 percent positive. Among the positive, cardiac injuries diagnosed by immediate thoracotomy were: right atrium 21.2 percent, right ventricle 30.3 percent, left ventricle 24,2 percent, ascending aorta 3 percent, no injury 21.2 percent. 35 patients died: 18 of them up to 24hs and 17 after 24hs. CONCLUSION: The pericardiostomy were performed mostly in young men with penetrating trauma caused by gunshot wounds., in its majority with injury of the right ventricle as main finding, which agreed to the reviwed literature.

Procedimientos pericárdicos percutáneos: resultados hospitalarios y en el primer año / Percutaneous Pericardial Procedures: In-Hospital and One-Year Outcomes

Introducción La ventana quirúrgica pleuropericárdica ha sido el tratamiento convencional del derrame pericárdico grave o taponamiento recidivante hasta el advenimiento de la pericardiotomía percutánea con balón. Objetivos Analizar nuestra experiencia inicial en procedimientos pericárdicos realizados en pacientes con derrame pericárdico. Material y métodos Se incluyeron 15 pacientes en forma consecutiva tratados con pericardiotomía percutánea con balón por derrame pericárdico grave o taponamiento. Se consideró éxito primario a la pericardiotomía percutánea con balón efectiva sin necesidad de una nueva intervención por derrame pericárdico y alta hospitalaria sin complicaciones mayores. Por la misma vía se realizó una biopsia pericárdica en 3 pacientes. Resultados El éxito primario se alcanzó en todos los procedimientos. En el seguimiento intrahospitalario, el derrame pleural fue la complicación menor más frecuente. En el seguimiento al año se produjeron 7 muertes atribuidas a la enfermedad de base sin que se observaran recidivas de derrame pericárdico. Conclusiones En nuestra serie de pacientes, la pericardiotomía percutánea con balón resultó una técnica útil y simple, con una tasa alta de éxito y una tasa baja de complicaciones y recidivas. La biopsia pericárdica percutánea podría agregar información diagnóstica en un mismo procedimiento.

Background Pericardial window has been the conventional treatment for severe pericardial effusion or recurrent cardiac tamponade before the advent of percutaneous balloon pericardiotomy. Objectives To analyze our initial experience with pericardial procedures in patients with pericardial effusion. Material and Methods A total of 15 consecutive patients underwent percutaneous balloon pericardiotomy due to severe pericardial effusion or cardiac tamponade. Primary success was defined as an effective percutaneous balloon pericardiotomy without the need of a new intervention due to pericardial effusion and absence of major complications during hospitalization. A pericardial biopsy was performed through the same route in 3 patients. Results The primary success was achieved in all the procedures. The most frequent complication during hospitalization was pleural effusion. One year after the procedure 7 patients had died due to the underlying condition; none of them had had recurrent pericardial effusion. Conclusions In our series of patients, percutaneous ballon pericardiotomy appeared to be a useful and simple technique, with a high rate of success and a low incidence of complications and recurrences. Percutaneous pericardial biopsy might add diagnostic information within the same procedure.