Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Pediatric Malignant Pericardial Effusion Medication

  • Author: Poothirikovil Venugopalan, MBBS, MD, FRCPCH; Chief Editor: Stuart Berger, MD  more...
 
Updated: Feb 04, 2014
 

Medication Summary

Hemodynamic support is of some value until drainage of pericardial fluid can be accomplished. Pericardiocentesis and intrapericardial sclerosis are effective therapies for malignant pericardial effusions that recur. Intrapericardial administration of drugs, such as cisplatin, can be important. Use anti-inflammatory drugs for viral pericarditis.

Next

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Class Summary

Nonsteroidal anti-inflammatory drugs (NSAIDs) are analgesics that offer anti-inflammatory action. They have analgesic, anti-inflammatory, and antipyretic activities. Their main mechanism of action is inhibition of cyclooxygenase activity and prostaglandin synthesis. They may act through other mechanisms as well (eg, by inhibiting leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell-membrane functions).

Ibuprofen (Advil, Motrin, Addaprin, Ultraprin)

 

Ibuprofen is a propionic acid derivative that reduces the formation of inflammatory mediators by enzyme inhibition.

Naproxen (Aleve, Anaprox, Naprosyn, Naprelan)

 

Naproxen is a propionic acid derivative that reduces the formation of inflammatory mediators by enzyme inhibition.

Diclofenac sodium (Cataflam, Voltaren SR, Zipsor)

 

Diclofenac possesses properties similar to those of the propionic acid derivatives and reduces the formation of inflammatory mediators by enzyme inhibition. The tablets are immediate-release formulations.

Indomethacin (Indocin)

 

Indomethacin behaves in the same manner as the propionic acid derivatives and inhibits the formation of inflammatory mediators. It is rapidly absorbed and is metabolized in the liver through demethylation, deacetylation, and glucuronide conjugation. Indomethacin inhibits prostaglandin synthesis.

Ketoprofen

 

Ketoprofen is used for relief of mild to moderate pain and inflammation. Small dosages are indicated initially in small patients, elderly patients, and patients with renal or liver disease. Doses higher than 75 mg do not increase the therapeutic effects. Administer high doses with caution, and closely observe the patient's response.

Previous
Next

Corticosteroids

Class Summary

Corticosteroids elicit anti-inflammatory and immunosuppressive properties and cause profound and varied metabolic effects. They modify the body’s immune response to diverse stimuli.

Prednisone

 

Prednisone is used for patients with severe inflammatory pericardial effusions or for those in whom initial treatment with NSAIDs has failed.

Methylprednisolone (Solu-Medrol, Depo-Medrol, A-Methapred)

 

Methylprednisolone is available in IV/IM and oral form. It decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing increased capillary permeability. It is used for patients with severe inflammatory pericardial effusions or for those in whom initial treatment with NSAIDs has failed.

Prednisolone (Pediapred, Prelone, Orapred, Millipred)

 

Prednisolone is available in tablet and liquid forms. It decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing increased capillary permeability. It is used for patients with severe inflammatory pericardial effusions or for those in whom initial treatment with NSAIDs has failed.

Previous
 
Contributor Information and Disclosures
Author

Poothirikovil Venugopalan, MBBS, MD, FRCPCH Consultant Pediatrician with Cardiology Expertise, Department of Child Health, Brighton and Sussex University Hospitals, NHS Trust; Honorary Senior Clinical Lecturer, Brighton and Sussex Medical School, UK

Poothirikovil Venugopalan, MBBS, MD, FRCPCH is a member of the following medical societies: Royal College of Paediatrics and Child Health, Paediatrician with Cardiology Expertise Special Interest Group, British Congenital Cardiac Association

Disclosure: Nothing to disclose.

Chief Editor

Stuart Berger, MD Medical Director of The Heart Center, Children's Hospital of Wisconsin; Associate Professor, Department of Pediatrics, Section of Pediatric Cardiology, Medical College of Wisconsin

Stuart Berger, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American College of Chest Physicians, American Heart Association, Society for Cardiovascular Angiography and Interventions

Disclosure: Nothing to disclose.

Acknowledgements

Hugh D Allen, MD Professor, Department of Pediatrics, Division of Pediatric Cardiology and Department of Internal Medicine, Ohio State University College of Medicine

Hugh D Allen, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Pediatric Society, American Society of Echocardiography, Society for Pediatric Research, Society of Pediatric Echocardiography, and Western Society for Pediatric Research

Disclosure: Nothing to disclose.

Ira H Gessner, MD Professor Emeritus, Pediatric Cardiology

Ira H Gessner, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology, American Heart Association, American Pediatric Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References
  1. Castillo JJ, Shum H, Lahijani M, Winer ES, Butera JN. Prognosis in primary effusion lymphoma is associated with the number of body cavities involved. Leuk Lymphoma. 2012 Jun 13. [Medline].

  2. Thomas-de-Montpreville V, Nottin R, Dulmet E, Serraf A. Heart tumors in children and adults: clinicopathological study of 59 patients from a surgical center. Cardiovasc Pathol. 2007 Jan-Feb. 16(1):22-8. [Medline].

  3. Bien E, Stefanowicz J, Aleszewicz-Baranowska J, et al. [Cardio-vascular disorders at the time of diagnosis of malignant solid tumours in children--own experiences]. Med Wieku Rozwoj. 2005 Jul-Sep. 9(3 Pt 2):551-9. [Medline].

  4. McCurdy MT, Shanholtz CB. Oncologic emergencies. Crit Care Med. 2012 Jul. 40(7):2212-22. [Medline].

  5. Medary I, Steinherz LJ, Aronson DC, La Quaglia MP. Cardiac tamponade in the pediatric oncology population: treatment by percutaneous catheter drainage. J Pediatr Surg. 1996 Jan. 31(1):197-9; discussion 199-200. [Medline].

  6. Ben-Horin S, Bank I, Guetta V, Livneh A. Large symptomatic pericardial effusion as the presentation of unrecognized cancer: a study in 173 consecutive patients undergoing pericardiocentesis. Medicine (Baltimore). 2006 Jan. 85(1):49-53. [Medline].

  7. Devlieger R, Hindryckx A, Van Mieghem T, Debeer A, De Catte L, Gewillig M, et al. Therapy for foetal pericardial tumours: survival following in utero shunting, and literature review. Fetal Diagn Ther. 2009. 25(4):407-12. [Medline].

  8. Walsh MA, Carcao M, Pope E, Lee KJ. Kaposiform hemangioendothelioma presenting antenatally with a pericardial effusion. J Pediatr Hematol Oncol. 2008 Oct. 30(10):761-3. [Medline].

  9. Tsai MH, Yang CP, Chung HT, Shih LY. Acute myeloid leukemia in a young girl presenting with mediastinal granulocytic sarcoma invading pericardium and causing superior vena cava syndrome. J Pediatr Hematol Oncol. 2009 Dec. 31(12):980-2. [Medline].

  10. Singh J, Rana SS, Kaur A, Srivastava V, Singh H, Sharma R. Intrapericardial teratoma presenting as recurrent pericardial tamponade: report of a case. Surg Today. 2009. 39(8):700-4. [Medline].

  11. Karatolios K, Pankuweit S, Moosdorf RG, Maisch B. Vascular endothelial growth factor in malignant and benign pericardial effusion. Clin Cardiol. 2012 Jun. 35(6):377-81. [Medline].

  12. Luna A, Ribes R, Caro P, et al. Evaluation of cardiac tumors with magnetic resonance imaging. Eur Radiol. 2005 Jul. 15(7):1446-55. [Medline].

  13. Palma JH, Gaia DF, Guilhen JC, Branco JN, Buffolo E. Video-thoracoscopic pericardial drainage in the treatment of pericardial effusions. Rev Bras Cir Cardiovasc. 2009 Mar. 24(1):44-9. [Medline].

  14. Georghiou GP, Stamler A, Sharoni E, et al. Video-assisted thoracoscopic pericardial window for diagnosis and management of pericardial effusions. Ann Thorac Surg. 2005 Aug. 80(2):607-10. [Medline].

  15. Puri A, Agarwal N, Dwivedi SK, Narain VS. Percutaneous balloon pericardiotomy for the treatment of recurrent malignant pericardial effusion. Indian Heart J. 2012 Jan-Feb. 64(1):88-9. [Medline].

  16. Jones DA, Jain AK. Percutaneous balloon pericardiotomy for recurrent malignant pericardial effusion. J Thorac Oncol. 2011 Dec. 6(12):2138-9. [Medline].

  17. Nieh S, Chen SF, Fu E, et al. Detection of the human telomerase RNA component by in situ hybridization in cells from body fluids. Acta Cytol. 2005 Jan-Feb. 49(1):31-7. [Medline].

  18. Politi E, Kandaraki C, Apostolopoulou C, et al. Immunocytochemical panel for distinguishing between carcinoma and reactive mesothelial cells in body cavity fluids. Diagn Cytopathol. 2005 Mar. 32(3):151-5. [Medline].

 
Previous
Next
 
Plain chest radiograph from 3-month-old infant with pneumonia and malignant pericardial effusion, showing cardiomegaly and bilateral pneumonic patches.
Two-dimensional echocardiograph from subcostal window, showing large pericardial effusion.
M-mode echocardiograph from child with pericardial effusion.
Cytologic features of malignant pericardial effusion. Smear of centrifuged pericardial fluid from patient with malignant pericardial involvement from lymphoma. Low-power view showing numerous mononuclear cells along with large atypical malignant cells.
Cytologic features of malignant pericardial effusion. Smear of centrifuged pericardial fluid from patient with malignant pericardial involvement from lymphoma. High-power view showing morphologic details of malignant cells. These cells are large and show oval hyperchromatic nuclei, some of them having nucleoli. Cytoplasm is reduced to thin rim.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.