Pericardial Effusion, Malignant 

  • Author: Poothirikovil Venugopalan, MBBS, MD, FRCP(Glasg), FRCPCH; Chief Editor: Stuart Berger, MD   more...
 
Updated: Jun 25, 2010
 

Background

Pericardial involvement in patients with malignancy is common. Widespread use of noninvasive diagnostic techniques, such as echocardiography and CT scanning, has increased awareness of this diagnosis. The mere presence of pericardial effusion does not necessarily imply pericardial infiltration by malignant cells.

See the image shown below.

Two-dimensional echocardiograph from a subcostal wTwo-dimensional echocardiograph from a subcostal window showing a large pericardial effusion.
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Pathophysiology

The pericardium consists of 2 layers, the visceral pericardium (epicardium) and the parietal pericardium, which enclose a potential space (ie, the pericardial cavity) between them. This cavity is normally lubricated by a very small amount of serous fluid (< 30 mL in adults). Inflammation of the pericardium or obstruction of lymphatic drainage from the pericardium of any etiology causes an increase in fluid volume, referred to as a pericardial effusion.

Malignant involvement of the pericardium, as depicted below, may be primary (less common) or secondary to spread from a nearby or distant focus of malignancy. Secondary neoplasms can involve the pericardium by contiguous extension from a mediastinal mass, nodular tumor deposits from hematogenous or lymphatic spread, and diffuse pericardial thickening from tumor infiltration (with or without effusion). In diffuse pericardial thickening, the heart may be encased by an effusive-constrictive pericarditis.

Cytologic features of malignant pericardial effusiCytologic features of malignant pericardial effusion. Smear of centrifuged pericardial fluid in a 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 effusiCytologic features of malignant pericardial effusion. Smear of centrifuged pericardial fluid in a patient with malignant pericardial involvement from lymphoma. High-power view showing morphologic details of the malignant cells. These cells are large and show oval hyperchromatic nuclei, some of them having nucleoli. The cytoplasm is reduced to a thin rim.

Other rare mechanisms include chronic myelomonocytic leukemia and intrapericardial extramedullary hematopoiesis with preleukemic conditions or during blast crisis in chronic myeloid leukemia. Obstruction of lymphatic drainage by mediastinal tumors, either benign or malignant, can also give rise to pericardial effusion, which can be chylous. The above mechanisms may act independently or jointly in any particular child with malignancy. The underlying myocardium is not involved in most patients.

Pathogenesis of clinical manifestations

In healthy individuals, the pericardium does not limit filling of the cardiac chambers either at rest or during exercise. When pericardial effusion occurs, chamber capacity may be reduced. Venous return may be severely limited and, therefore, cardiac output may be severely limited. Capacity of the pericardial space is influenced by its natural stiffness. Rapid accumulation of fluid is poorly tolerated, whereas slow accumulation may allow large amounts of pericardial fluid to collect without producing symptoms. With increased pressure within the pericardial space, filling pressure in all chambers of the heart is elevated. In advanced stages, right and left atrial mean pressures and right and left ventricular end-diastolic pressures are virtually identical to the intrapericardial pressure. Therefore, the clinical features result from limitation of cardiac output and elevated venous pressures.

Pulsus paradoxus

In healthy individuals, inspiration causes the systolic blood pressure to fall slightly as a result of the greater volume of blood accommodated by the pulmonary vascular bed. This occurs despite inspiratory increase in venous return to the right heart. In cardiac tamponade, right ventricular filling is maintained at the expense of restricted left ventricular filling, and the systolic blood pressure falls further (>10 mm Hg). This exaggerated fall in systolic blood pressure with inspiration is referred to as pulsus paradoxus. This is an important sign of cardiac tamponade, although, occasionally, severe respiratory distress of any cause (asthma, emphysema, pleural effusion) may give rise to this sign.

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Epidemiology

Frequency

United States

Pericardial effusion is a common cause of pericarditis, occurring in approximately 5-15% of patients with malignant neoplasms, according to autopsy data.

Most cardiac tumors in infants and children are benign (eg, rhabdomyoma, fibromas) and are rarely associated with pericardial involvement.[1]

International

A study of 236 children in Poland reported cardiac involvement in 15% of children, including pericardial effusion in 7% of children.[2]

Mortality/Morbidity

Children with pericardial involvement due to malignancy have more extensive disease and, hence, a worse prognosis; pericardial tamponade may add to the mortality unless promptly detected and appropriately treated.[2, 3]

Sex

Both sexes are affected. Medary et al reported higher incidence in males than in females at a ratio of 7:3.[4]

Age

All ages are affected, but pericardial effusion is more common in older children and adolescents. Medary et al reported a mean age of 14 y.[4] This may be related to the longer survival of older children with malignancy.

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Contributor Information and Disclosures
Author

Poothirikovil Venugopalan, MBBS, MD, FRCP(Glasg), FRCPCH,  Consulting Staff, Department of Child Health, University Hospital of North Tees and Hartlepool, UK

Poothirikovil Venugopalan, MBBS, MD, FRCP(Glasg), FRCPCH, is a member of the following medical societies: British Cardiac Society, Royal College of Paediatrics and Child Health, and Royal College of Physicians and Surgeons of Glasgow

Disclosure: Nothing to disclose.

Specialty Editor Board

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; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

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.

Gilbert Z Herzberg, MD  Assistant Professor, Department of Pediatrics, Section of Pediatric Cardiology, New York Medical College; Consulting Staff, Department of Pediatrics, Sound Shore Medical Center

Gilbert Z Herzberg, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Chief Editor

Stuart Berger, MD  Professor of Pediatrics, Division of Cardiology, Medical College of Wisconsin; Chief of Pediatric Cardiology, Medical Director of Pediatric Heart Transplant Program, Medical Director of The Heart Center, Children's Hospital 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, and Society for Cardiac Angiography and Interventions

Disclosure: Nothing to disclose.

References

  1. 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. Jan-Feb 2007;16(1):22-8. [Medline].

  2. 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. Jul-Sep 2005;9(3 Pt 2):551-9. [Medline].

  3. 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). Jan 2006;85(1):49-53. [Medline].

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

  5. Abadi MA, Zakowski MF. Cytologic features of sarcomas in fluids. Cancer. Apr 25 1998;84(2):71-6. [Medline].

  6. Arya LS, Narain S, Thavaraj V, et al. Leukemic pericardial effusion causing cardiac tamponade. Med Pediatr Oncol. Apr 2002;38(4):282-4. [Medline].

  7. Ascoli V, Taccogna S, Scalzo CC, Nardi F. Utility of cytokeratin 20 in identifying the origin of metastatic carcinomas in effusions. Diagn Cytopathol. Jun 1995;12(4):303-8. [Medline].

  8. Bardales RH, Stanley MW, Schaefer RF, et al. Secondary pericardial malignancies: a critical appraisal of the role of cytology, pericardial biopsy, and DNA ploidy analysis. Am J Clin Pathol. Jul 1996;106(1):29-34. [Medline].

  9. Bath LE, Walayat M, Mankad P, et al. Stage IV malignant intrapericardial germ cell tumor: a case report. Pediatr Hematol Oncol. Sep-Oct 1997;14(5):451-5. [Medline].

  10. Batlle M, Ribera JM, Larrousse E, et al. Cardiac tamponade as the initial manifestation of acute leukemia: report of a case and review of the literature. Haematologica. Nov-Dec 1991;76(6):505-7. [Medline].

  11. Benatar A, Vaughan J, Nicolini U, et al. Prenatal pericardiocentesis: its role in the management of intrapericardial teratoma. Obstet Gynecol. May 1992;79(5 ( Pt 2)):856-9. [Medline].

  12. Braunschweig R, Guilleret I, Delacretaz F, et al. Pitfalls in TRAP assay in routine detection of malignancy in effusions. Diagn Cytopathol. Oct 2001;25(4):225-30. [Medline].

  13. Cartagena AM, Levin TL, Issenberg H, Goldman HS. Pericardial effusion and cardiac hemangioma in the neonate. Pediatr Radiol. 1993;23(5):384-5. [Medline].

  14. Ceresoli GL, Ferreri AJ, Bucci E, et al. Primary cardiac lymphoma in immunocompetent patients: diagnostic and therapeutic management. Cancer. Oct 15 1997;80(8):1497-506. [Medline].

  15. Chan HS, Sonley MJ, Moes CA, et al. Primary and secondary tumors of childhood involving the heart, pericardium, and great vessels. A report of 75 cases and review of the literature. Cancer. Aug 15 1985;56(4):825-36. [Medline].

  16. Chang JS, Young ML, Chuu WM, Lue HC. Infantile cardiac hemangioendothelioma. Pediatr Cardiol. Jan 1992;13(1):52-5. [Medline].

  17. Cullinane CA, Paz IB, Smith D, et al. Prognostic factors in the surgical management of pericardial effusion in the patient with concurrent malignancy. Chest. Apr 2004;125(4):1328-34. [Medline].

  18. Czader M, Ali SZ. Flow cytometry as an adjunct to cytomorphologic analysis of serous effusions. Diagn Cytopathol. Aug 2003;29(2):74-8. [Medline].

  19. da Costa CM, de Camargo B, Gutierrez y Lamelas R, et al. Cardiac tamponade complicating hyperleukocytosis in a child with leukemia. Med Pediatr Oncol. Aug 1999;33(2):120-3; discussion 124. [Medline].

  20. Daubeney PE, Ogilvie BC, Moore IE, Webber SA. Intrapericardial lymphangioma presenting as neonatal cardiac tamponade. Pediatr Cardiol. Mar-Apr 1996;17(2):129-31. [Medline].

  21. Davidson B. Malignant effusions: from diagnosis to biology. Diagn Cytopathol. Oct 2004;31(4):246-54. [Medline].

  22. Davidson B, Risberg B, Kristensen G, et al. Detection of cancer cells in effusions from patients diagnosed with gynaecological malignancies. Evaluation of five epithelial markers. Virchows Arch. Jul 1999;435(1):43-9. [Medline].

  23. del Barrio LG, Morales JH, Delgado C, et al. Percutaneous balloon pericardial window for patients with symptomatic pericardial effusion. Cardiovasc Intervent Radiol. Sep-Oct 2002;25(5):360-4. [Medline].

  24. Donadieu J, Canioni D, Cuenod B, et al. A familial T-cell lymphoma with gamma delta phenotype and an original location. Possible role of chronic Epstein-Barr virus infection. Cancer. Apr 15 1996;77(8):1571-7. [Medline].

  25. Eyskens B, Lawrenson J, Moerman P, et al. Brief report. Sudden death following removal of pericardial fluid in a child presenting with mediastinal lymphoma. Med Pediatr Oncol. Dec 1998;31(6):547-8. [Medline].

  26. Fang BR, Chiang CW, Hung JS, et al. Cardiac myxoma--clinical experience in 24 patients. Int J Cardiol. Dec 1990;29(3):335-41. [Medline].

  27. Fernandes F, Ianni BM, Arteaga E, et al. Value of pericardial biopsy in the etiologic diagnosis of pericardial diseases [in Portuguese]. Arq Bras Cardiol. Jun 1998;70(6):393-5. [Medline].

  28. Geissbuhler K, Leiser A, Fuhrer J, Ris HB. Video-assisted thoracoscopic pericardial fenestration for loculated or recurrent effusions. Eur J Cardiothorac Surg. Oct 1998;14(4):403-8. [Medline].

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

  30. Gerber TC, Safford RE. Intrapericardial Doppler flow signals in cardiac tamponade. Clin Cardiol. Mar 1999;22(3):231-2. [Medline].

  31. Girardi LN, Ginsberg RJ, Burt ME. Pericardiocentesis and intrapericardial sclerosis: effective therapy for malignant pericardial effusions. Ann Thorac Surg. Nov 1997;64(5):1422-7; discussion 1427-8. [Medline].

  32. Graham SJ, Duval-Arnould B, Mercado TC, Trepel JB, Cotelingam JD. Burkitt's lymphoma: a pericardial presentation. Cytopathology. 1990;1(4):239-42. [Medline].

  33. Hallman JR, Geisinger KR. Cytology of fluids from pleural, peritoneal and pericardial cavities in children. A comprehensive survey. Acta Cytol. Mar-Apr 1994;38(2):209-17. [Medline].

  34. Hoffmann U, Globits S, Schima W, et al. Usefulness of magnetic resonance imaging of cardiac and paracardiac masses. Am J Cardiol. Oct 1 2003;92(7):890-5. [Medline].

  35. Hudnall SD, Melez K, Galindo A, Bryson Y. Massive pseudolymphomatous pericardial effusion in the posttransplant setting mimicking posttransplant lymphoproliferative disease. Transplantation. Jun 27 1996;61(12):1776-8. [Medline].

  36. Karimi M, Eshghi P. Unusual lymphoblastic leukemia/lymphoma in Eastern Iran. Indian J Pediatr. Jul 2006;73(7):619-22. [Medline].

  37. Kawakami K, Horigome H, Tsuchida M, et al. Right atrial hemangiopericytoma with hemopericardium during infancy. Pediatr Cardiol. Jan-Feb 1995;16(1):48-50. [Medline].

  38. Kondo M, Kojima S, Horibe K, et al. Hemolytic uremic syndrome after allogeneic or autologous hematopoietic stem cell transplantation for childhood malignancies. Bone Marrow Transplant. Feb 1998;21(3):281-6. [Medline].

  39. Krikorian JG, Hancock EW. Pericardiocentesis. Am J Med. Nov 1978;65(5):808-14. [Medline].

  40. Kulthe SG, Nadkarni UB, Singh A, et al. Recurrent Cardiac tamponade: intrapericardial teratoma. Indian Pediatr. Jan 1995;32(1):88-91. [Medline].

  41. Laga S, Gewillig MH, Van Schoubroeck D, Daenen W. Imminent fetal cardiac tamponade by right atrial hemangioma. Pediatr Cardiol. Sep-Oct 2006;27(5):633-5. [Medline].

  42. Lazzarino M, Orlandi E, Paulli M, et al. Treatment outcome and prognostic factors for primary mediastinal (thymic) B-cell lymphoma: a multicenter study of 106 patients. J Clin Oncol. Apr 1997;15(4):1646-53. [Medline].

  43. Lin YW, Kubota M, Matsumura M, et al. T cell leukemia with pericardial effusion at diagnosis. Pediatr Hematol Oncol. Oct-Dec 1993;10(4):379-80. [Medline].

  44. Lindenberger M, Kjellberg M, Karlsson E, Wranne B. Pericardiocentesis guided by 2-D echocardiography: the method of choice for treatment of pericardial effusion. J Intern Med. Apr 2003;253(4):411-7. [Medline].

  45. Loire R, Saint-Pierre A. Radiation-induced pericarditis. Long-term outcome. 45 cases with thoracotomy and biopsy [in French]. Presse Med. Dec 8 1990;19(42):1931-6. [Medline].

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

  47. MacKenzie S, Loken S, Kalia N, et al. Intrapericardial teratoma in the perinatal period. Case report and review of the literature. J Pediatr Surg. Dec 2005;40(12):e13-8. [Medline].

  48. Maisch B, Pankuweit S, Brilla C, et al. Intrapericardial treatment of inflammatory and neoplastic pericarditis guided by pericardioscopy and epicardial biopsy--results from a pilot study. Clin Cardiol. Jan 1999;22(1 Suppl 1):I17-22. [Medline].

  49. Malamou-Mitsi VD, Zioga AP, Agnantis NJ. Diagnostic accuracy of pericardial fluid cytology: an analysis of 53 specimens from 44 consecutive patients. Diagn Cytopathol. Sep 1996;15(3):197-204. [Medline].

  50. Manetti A, De Simone L, Pollini I, et al. Generalized lymphangiomatosis with chylopericardium [in Italian]. Pediatr Med Chir. Jan-Feb 1994;16(1):81-3. [Medline].

  51. Marcy PY, Bondiau PY, Brunner P. Percutaneous treatment in patients presenting with malignant cardiac tamponade. Eur Radiol. Sep 2005;15(9):2000-9. [Medline].

  52. Markiewicz W, Glatstein E, London EJ, Popp RL. Echocardiographic detection of pericardial effusion and pericardial thickening in malignant lymphoma. Radiology. Apr 1977;123(1):161-4. [Medline].

  53. Markman M. Common complications and emergencies associated with cancer and its therapy. Cleve Clin J Med. Mar-Apr 1994;61(2):105-14; quiz 162. [Medline].

  54. Martinez-Lopez JI. ECG of the month. The swinging heart. Electrical alternans. J La State Med Soc. Apr 1990;142(4):5-8. [Medline].

  55. McClain JL, Clark MA, Sandusky GE. Undiagnosed, untreated acute lymphoblastic leukemia presenting as suspected child abuse. J Forensic Sci. May 1990;35(3):735-9. [Medline].

  56. McDonald JM, Meyers BF, Guthrie TJ, et al. Comparison of open subxiphoid pericardial drainage with percutaneous catheter drainage for symptomatic pericardial effusion. Ann Thorac Surg. Sep 2003;76(3):811-5; discussion 816. [Medline].

  57. Meyers DG, Meyers RE, Prendergast TW. The usefulness of diagnostic tests on pericardial fluid. Chest. May 1997;111(5):1213-21. [Medline].

  58. Mihaescu A, Gebhard S, Chaubert P, et al. Application of molecular genetics to the diagnosis of lymphoid-rich effusions: study of 95 cases with concomitant immunophenotyping. Diagn Cytopathol. Aug 2002;27(2):90-5. [Medline].

  59. Mishra OP, Yusuf S, Ali Z, Nath G. Lysozyme levels for the diagnosis of tuberculous effusions in children. J Trop Pediatr. Oct 2000;46(5):296-300. [Medline].

  60. Moores DW, Allen KB, Faber LP, et al. Subxiphoid pericardial drainage for pericardial tamponade. J Thorac Cardiovasc Surg. Mar 1995;109(3):546-51; discussion 551-2. [Medline].

  61. Mouallem M, Wolf I, Mindlin G, Farfel Z. Pericardial tamponade-associated hyponatremia. Am J Med Sci. Jan 2003;325(1):51-2. [Medline].

  62. Mueller XM, Tevaearai HT, Hurni M, et al. Long-term results of surgical subxiphoid pericardial drainage. Thorac Cardiovasc Surg. Apr 1997;45(2):65-9. [Medline].

  63. Mukai K, Shinkai T, Tominaga K, Shimosato Y. The incidence of secondary tumors of the heart and pericardium: a 10- year study. Jpn J Clin Oncol. Sep 1988;18(3):195-201. [Medline].

  64. 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. Jan-Feb 2005;49(1):31-7. [Medline].

  65. Ohnishi M, Niwayama H, Miyazawa Y, et al. Echocardiography in patients with malignant metastatic neoplasms of the heart and great vessels [in Japanese]. J Cardiol. 1990;20(2):377-84. [Medline].

  66. Parwani AV, Ali TZ, Ali SZ. Pathologic quiz case: a 15-year-old adolescent girl with supraclavicular lymphadenopathy and pleural and pericardial effusions. Arch Pathol Lab Med. Jun 2003;127(6):e288-90. [Medline].

  67. Perkkio M, Tikanoja T, Marin S. Leukemic coronary artery occlusion in a child with acute lymphoblastic leukemia. Pediatr Cardiol. Jan-Feb 1997;18(1):64-5. [Medline].

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

  69. Pomjanski N, Motherby H, Buckstegge B, et al. Early diagnosis of mesothelioma in serous effusions using AgNOR analysis. Anal Quant Cytol Histol. Apr 2001;23(2):151-60. [Medline].

  70. Posner MR, Cohen GI, Skarin AT. Pericardial disease in patients with cancer. The differentiation of malignant from idiopathic and radiation-induced pericarditis. Am J Med. Sep 1981;71(3):407-13. [Medline].

  71. Puthanakit T, Pongprot Y, Borisuthipandit T, et al. A mediastinal mass resembling lymphoma: an unusual manifestation of probable case of invasive zygomycosis in an immunocompetent child. J Med Assoc Thai. Oct 2005;88(10):1430-3. [Medline].

  72. Rienmuller R, Tiling R. Evaluation of paracardiac and intracardiac masses in children. Semin Ultrasound CT MR. Jun 1990;11(3):246-50. [Medline].

  73. Rinkevich D, Borovik R, Bendett M, Markiewicz W. Malignant pericardial tamponade. Med Pediatr Oncol. 1990;18(4):287-91. [Medline].

  74. Rosenkranz ER, Murphy DJ Jr. Diagnosis and neonatal resection of right atrial angiosarcoma. Ann Thorac Surg. Apr 1994;57(4):1014-5. [Medline].

  75. Shimoyama Y, Kawada K, Imamura H. A functioning intrapericardial paraganglioma (pheochromocytoma). Br Heart J. Apr 1987;57(4):380-3. [Medline].

  76. Sklansky M, Greenberg M, Lucas V, Gruslin-Giroux A. Intrapericardial teratoma in a twin fetus: diagnosis and management. Obstet Gynecol. May 1997;89(5 Pt 2):807-9. [Medline].

  77. Spottswood SE, Goble MM, Massey GV, Ben-Ezra JM. Acute monoblastic leukemia presenting with pericardial effusion and cardiac tamponade. Pediatr Radiol. 1994;24(7):494-5. [Medline].

  78. Szturmowicz M, Tomkowski W, Fijalkowska A, et al. Diagnostic utility of CYFRA 21-1 and CEA assays in pericardial fluid for the recognition of neoplastic pericarditis. Int J Biol Markers. Jan-Mar 2005;20(1):43-9. [Medline].

  79. Toren A, Nagler A. Massive pericardial effusion complicating the course of chronic graft- versus-host disease (cGVHD) in a child with acute lymphoblastic leukemia following allogeneic bone marrow transplantation. Bone Marrow Transplant. Nov 1997;20(9):805-7. [Medline].

  80. Vassilopoulos PP, Nikolaidis K, Filopoulos E, Griniatsos J, Efremidou A. Subxiphoidal pericardial 'window' in the management of malignant pericardial effusion. Eur J Surg Oncol. Oct 1995;21(5):545-7. [Medline].

  81. Wilkes JD, Fidias P, Vaickus L, Perez RP. Malignancy-related pericardial effusion. 127 cases from the Roswell Park Cancer Institute. Cancer. Oct 15 1995;76(8):1377-87. [Medline].

  82. Wong JW, Pitlik D, Abdul-Karim FW. Cytology of pleural, peritoneal and pericardial fluids in children. A 40-year summary. Acta Cytol. Mar-Apr 1997;41(2):467-73. [Medline].

  83. Woods T, Vidarsson B, Mosher D, Stein JH. Transient effusive-constrictive pericarditis due to chemotherapy. Clin Cardiol. Apr 1999;22(4):316-8. [Medline].

  84. Zendehrokh N, Dejmek A. Telomere repeat amplification protocol (TRAP) in situ reveals telomerase activity in three cell types in effusions: malignant cells, proliferative mesothelial cells, and lymphocytes. Mod Pathol. Feb 2005;18(2):189-96. [Medline].

  85. .

  86. 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. Dec 2009;31(12):980-2. [Medline].

  87. 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].

  88. 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].

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

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

 
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Plain chest radiograph in a 3-month-old infant with pneumonia and malignant pericardial effusion showing cardiomegaly and bilateral pneumonic patches.
Two-dimensional echocardiograph from a subcostal window showing a large pericardial effusion.
M-mode echocardiograph in a child with pericardial effusion.
Cytologic features of malignant pericardial effusion. Smear of centrifuged pericardial fluid in a 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 in a patient with malignant pericardial involvement from lymphoma. High-power view showing morphologic details of the malignant cells. These cells are large and show oval hyperchromatic nuclei, some of them having nucleoli. The cytoplasm is reduced to a thin rim.
 
 
 
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