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C. Wang
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P2.01 - Poster Session/ Treatment of Advanced Diseases – NSCLC (ID 207)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Advanced Diseases - NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/08/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P2.01-046 - Making the Diagnosis of Cardiac Tamponade in Lung Cancer Patients (ID 2175)
09:30 - 09:30 | Author(s): C. Wang
- Abstract
Background:
Malignant pericardial effusions are common in lung cancer (LC) and can produce cardiac tamponade (CT). This oncologic emergency requires a high index of suspicion for accurate, prompt diagnosis. To study how CT is diagnosed in LC, we reviewed symptoms, signs and differential diagnoses recorded, and tests obtained, at a tertiary teaching hospital.
Methods:
Records of patients hospitalized with a diagnosis of CT between April 1999 and September 2011 were reviewed, focusing on LC related CT. Extent of disease, treatment history and response, symptoms, vital signs, physical exam and EKG findings recorded by the initial and admitting physicians were recorded, together with differential diagnoses mentioned in the physician notes before radiologic testing. Finally, the radiologic tests used to make or confirm the diagnosis were recorded.
Results:
Of 770 patients with a diagnosis of CT, 57 had malignant CT and 26 had LC. Of these, 7 (27%) were newly diagnosed with cancer at the time of diagnosis of CT. The most common symptom, shortness of breath, was present in 24 (92%) cases. Physical exam findings recorded by physicians are listed in Table 1. EKG findings of low QRS voltage/electrical alternans were present in 3, absent in 3 and were not documented in 20 patients. In only 8 cases (31%) CT was included in the differential diagnosis based on the signs, symptoms and EKG findings at initial presentation. Of these, 3 had a known prior history of pericardial effusion and 3 were newly diagnosed with LC at the time of presentation. Two of these diagnoses were made by oncologists and the other 6 were made by Emergency physicians (ED)/internists. In the remaining 18 cases, the diagnosis was made serendipitously with imaging studies obtained for other reasons. Of these, 5 patients had a known history of malignant pericardial disease and 6 were newly diagnosed with LC. The physician seeing the patient initially was an oncologist in 5 cases and an ED /internist in 13 cases.Jugular venous distention Distant heart sounds Pulsus paradoxus Tachycardia Hypotension Present 7 (27%) 5 (19.2%) 3 (11.5%) 22 (84.6%) 6 (23%) Absent 10 (38.4%) - 4 (15.3%) 4 (15.3%) 20 (77%) Not recorded 9 (34.6%) 21 (80.7%) 19 (73%) - -
Conclusion:
Not including CT in the differential diagnosis of LC patients presenting with dyspnea is common among physicians of all types, including oncologists, internists, and ED. Physicians should include CT in the differential diagnosis of LC patients presenting with dyspnea and tachycardia, especially those with advanced disease, and a careful physical examination will elicit the classic signs in a substantial proportion of patients. Without a high index of clinical suspicion the diagnosis may be delayed or missed.
