PMC6029438_01
Transthoracic echocardiogram, parasternal long view, demonstrating large pericardial effusion and RV diastolic collapse.
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Due to high clinical suspicion for cardiac tamponade, a bedside transthoracic echocardiogram (TTE) was obtained which showed a large pericardial effusion with diastolic compression of the right ventricle, suggestive of cardiac tamponade, as well as mild left ventricular systolic dysfunction (see Figures 1 and 2).
Transthoracic echocardiogram, subcostal view.
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fig2
Due to high clinical suspicion for cardiac tamponade, a bedside transthoracic echocardiogram (TTE) was obtained which showed a large pericardial effusion with diastolic compression of the right ventricle, suggestive of cardiac tamponade, as well as mild left ventricular systolic dysfunction (see Figures 1 and 2).
(a) H&E section shows thickening and fibrosis of the pericardium (asterisk) and scattered aggregates of metastatic urothelial carcinoma (black arrows). Insert: high power view of the malignant cells. The pericardial effusion demonstrates 3D clusters of large highly atypical malignant cells (b, Papanicolaou stain), variable in size and hyperchromatic with a high nuclear to cytoplasmic ratio (c, Diff-Quick stain). The malignant cells are immunoreactive for uroplakin and MOC-31 while negative for calretinin (not shown).
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The pericardial fluid cytology and pericardial biopsy were both positive for malignancy, consistent with metastatic UC (see Figure 3).
CT scan of the chest obtained one week after the pericardial window showing loculated pericardial fluid adjacent to the right atrium that is slightly higher in attenuation, suggestive of bloody or proteinaceous effusion.
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Subsequently, he was noted to have recurrent pericardial effusion suggesting failure of treatment (see Figure 4).