What is cervical vein obstruction

Neoplastic pericarditis

introduction

Introduction to neoplastic pericarditis

Neoplastic periculitis (neoplastic pericarditis) is caused by malignant tumor metastases or primary pericardial tumors such as mesothelioma. 80% were reported lung cancer, breast cancer, leukemia, Hodgkin's disease, and non-Hodgkin's lymphoma.

Basic knowledge

Sickness rate: 0.0012%

Vulnerable people: no specific population

Type of infection: not contagious

Complications: constrictive pericarditis

Pathogen

Causes of Neoplastic Pericarditis

(1) causes of 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 The malignant teratoma, a rare pericardial tumor that occasionally occurs with congenital diseases If tuberculosis occurs and catecholamine pheochromocytoma is eliminated, it is also a rare primary pericardial tumor in some AIDS patients. Due to Kaposi's sarcoma and cardiac lymphoma, the number of cases of malignant pericardial and heart disease is increasing, and cardiac tamponade may occur in the early stages of HIV infection.

2. Pericardial metastasis Tumor cancer metastatic routes are:

1 malignant mediastinal tumor spreads and attaches to the pericardium.

2 tumor nodules are deposited in the pericardium through dissemination of blood or lymph.

3 Tumor diffuse infiltration of pericardium.

4 primary pericardial tumor, local infiltration of the pericardium, in most cases the epicardium and myocardium are not affected.

3. Neoplastic pericardial effusion: The neoplasmic pericardial effusion appears as serous blood, rapid development, can lead to acute or subacute cardiac tamponades, pericardial tumors such as sarcoma, mesothelioma and melanoma, the ventricular and pericardial cavities can rupture cause pericardial thickening and pericardial effusion (exudation-constrictive pericarditis) or tumor growth envelop the entire heart.

4. Mediastinal tumor complicated with pericardial effusion is not malignant, mediastinal lymphoma and Hodgkin's disease often appear asymptomatic Pericardial effusion, this temporary pericardial effusion, possibly the result of a lymphatic drainage disorder, mediastinal thymoma and original primary heart tumors can also be complicated by transient pericardium.

(two) pathogenesis

The routes of metastatic cancer that affect the pericardium are:

1 malignant mediastinal tumor is widespread on the pericardium;

2 tumor nodules deposited in the pericardium through blood-borne or lymphatic dissemination;

3 tumor infiltration diffuse pericardium;

4 primary pericardial pericardial tumor local infiltration, most patients with myocardium not tired.

In tumor pericarditis, bloody pericardial effusion occurs and development is abnormally rapid, leading to acute or subacute cardiac tamponade syndrome, pericardial mesothelioma, and sarcoma. Heart tamponade.

prevention

Prevention of neoplastic pericarditis

1. Good job in preventing common tumors is a positive measure to radically reduce the incidence of tumors: When preventing tumors: 1 The etiology of cancer prevention: changing bad habits like smoking, eating and healing, eating moldy, etc. , Patients with a family history of cancer should pay special attention to prevention, 2 common tumors should be counted, 1 to 2 physical exams should be done per year to detect tumors early.

2. Early detection, early detection, early treatment of common tumors and preventing the disease from progressing to late complications are difficult to control.

complication

Complications of neoplastic pericarditisComplications, constrictive pericarditis

Complications such as cardiac tamponade and constrictive pericarditis are common.

1. Cardiac tamponade: neoplastic pericarditis often worsens rapidly within a few months, the exudate grows rapidly and there is a strong 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 effusion or tumor growth that envelop the entire heart and form narrowing pericarditis.

symptom

Tumor Pericarditis Symptoms CommonSymptoms Neck vein obstruction Bloody exudate Pericardial effusion Qi pulse Chest pain Dyspnoea Pericardium Pericardial inflammation

Tumor pericarditis has no specific symptoms, some patients have the most noticeable symptoms of dyspnea, they may have chest pain, cough, and liver, and most patients have obvious signs of cardiac tamponade, such as: When the pulse and hypotension are diagnosed, auscultation of the heart is far away and the rubbing sound of the pericardium is less audible.

If the patient is known to have malignant tumors and there are signs of pericarditis, profuse pericardial effusion, and rapid growth or bloody exudate, the possibility of neoplastic pericarditis should be suspected, e.g. B. if the patient has no primary malignant tumor and only found blood pericardial exudate, at the same time can rule out other causes of pericardial exudate, the disease quickly worsens in a few months, and the exudate grows rapidly, can 800 ~ 1000ml every few days (otherwise there is heart tamponade), mesothelioma should be suspect.

Investigate

Tumor pericarditis

When bacterial screening of pericardial fluid is performed, 85% of patients can detect cancer cells or primary heart tumor cells such as mesothelioma cells that have been transferred from other parts of the body.

1. Chest x-ray: More than 90% have pleural effusion, heart enlargement, mediastinal dilation, hilum mass or occasional heart shadow contours, irregular nodules.

2. EKG examination: That Electrocardiogram showed unspecific changes, tachycardia, ST-T changes, low QRS voltage, and occasional atrial fibrillation. The EKG of some patients showed persistent tachycardia, EKG performance in early pericarditis when the EKG appeared clear. Ventricular conduction disorders suggest that the tumor has infiltrated the myocardial and cardiac conduction systems.

3. Ultrasound examination of the heart: Signs of pericardial effusion, visible irregular mass protruding into the pericardium.

4. CT and magnetic resonance imaging: Pericardial effusion and localized masses protruding into the pericardial cavity.

diagnosis

Diagnosis and diagnosis of neoplastic pericarditis

Differential diagnosis

Cancer patients with pericarditis are not caused by cancer itself, like pericarditis after radiation therapy, immunosuppressive drugs induce tuberculous or fungal pericarditis, there are some reports, intravenous chemotherapy drug doxorubicin, soft red acute pericarditis occurs in the presence of themycin.

Cardiac tamponade of neoplastic pericarditis must be distinguished from jugular venous insufficiency, hepatomegaly, and peripheral edema due to other causes in cancer patients.

1 doxorubicin myocardial toxicity or the original heart disease, left and right cardiac dysfunction progressively worse;

2 obstruction of superior vena cava;

3 liver tumor portal hypertension;

Echocardiography, in addition to detecting pericardial effusion, can also help understand the location of the tumor and pericardium, mediastinum and lungs. The relationship between.

Pericardial Puncture and Cardiac Catheterization: Echocardiography has shown that a large number of pericardial effusions suspected of having cardiac tamponade in cancer patients using indwelling pericardial puncture catheters can identify:

1 obstruction of the superior vena cava, can occur in addition to neoplastic pericarditis, cardiac tamponade, facial edema, dilation of the jugular vein and cardiac catheter;

2 Cyanosis, hypoxemia and pulmonary vascular resistance are not necessarily the characteristics of a cardiac tamponade. After a pericardial puncture, the patient still has hypoxemia and persistent dyspnea, which strongly support pulmonary microvascular tumors (neoplastic). Lymphitis and lung spread), blood samples taken from the right heart, catheterized pulmonary capillary insufficiency, cytological examination can provide clues to diagnosis.

Since the occurrence of pericardial effusion cannot differentiate between neoplastic, radioactive, or specific cause of pericarditis, the diagnosis of 85% of malignant pericarditis can be based on cytological results. Cancer pericarditis, false negative cytology, is not common but does not include lymphoma and mesothelioma. If tumor pericarditis is suspected, the pericardial effusion should contain carcinoembryonic antigen to improve the positive rate of diagnosis of the cells. Negative test results may require a happy bag for the biopsy. Pericardial biopsy specimens should be large enough to provide a histological diagnosis in more than 90% of cases. If the sample is too small, there may be a false negative diagnosis. A happy biopsy is available for critically ill patients. 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.