Sudden death due to cardiac tamponade from malignant pericardial involvement by metastatic lung cancer
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Sudden death due to cardiac tamponade from malignant pericardial involvement by metastatic lung cancer Robert Cassady • Joseph A. Prahlow
Accepted: 8 September 2014 / Published online: 19 October 2014 Ó Springer Science+Business Media New York 2014
Case report After being ill with an ‘‘upper respiratory infection’’ for approximately 2 weeks duration, a 45-year-old black female called 911 due to vomiting and diarrhea of 2 days duration and then new onset of shortness of breath. When paramedics arrived at her home she was conscious, but upon transferring her to the stretcher, she had more trouble breathing and became unresponsive. Emergency advanced cardiac life support measures were immediately initiated, and she was transported to a local Emergency Department (ED). Upon arrival at the hospital, her Glasgow Coma Scale was 3 and cardiac monitoring showed pulseless electrical activity. Emergent chest X-ray revealed a somewhat enlarged heart and a possible right-sided pleural effusion, but no evidence of masses or lymphadenopathy (Fig. 1). A head CT and an enzyme immunoassay screen for influenza were negative. Resuscitation efforts were continued for a time but without success. The patient died in the ED approximately 25 min after arrival, without a known explanation for death. As such, the case was referred to the coroner’s office for further investigation. Death investigation revealed that the patient had been treated at a health clinic for a productive cough, chest pain, sore throat, and generalized achiness of 3 days duration 4 days prior to death. She was given a Z-Pak and Robitussin AC for a possible upper respiratory infection
and bronchitis. The only available past medical history was benign hypertension; the patient had a history of smoking. A coroner’s autopsy was performed on the day of death. Upon removal of the anterior chest plate with exposure of the pericardial cavity, a hemorrhagic infiltrative process was found that extensively involved the epicardium and pericardium, with 500 mL of liquid blood within the pericardial cavity (Figs. 2, 3). Subsequent examination of the lungs revealed a 3 9 3 9 2 cm subpleural mass within the upper medial aspect of the lower lobe of the right lung (Fig. 4). There were focal white nodules on the left pleural surface and onto the left hemidiaphragm as large as 1 cm, as well as pulmonary hilar lymphadenopathy. Microscopically, the primary lung tumor was an adenocarcinoma with areas of squamous differentiation, with extensive metastases involving the epicardium/pericardium, lymph nodes, mediastinal soft tissues, and spleen. The lungs were also emphysematous. Other notable findings included atherosclerosis of the aorta, mild to severe atherosclerosis in the coronary arteries, and nephroarteriolosclerosis. Based on the autopsy findings, the cause of death was cardiac tamponade due to hemopericardium related to diffuse involvement of the epicardium and pericardium by adenocarcinoma of the lung. The manner of death was natural.
Discussion R. Cassady J.
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