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Pericardial disease associated with malignancy

Barry A Borlaug, MD
Malcolm M DeCamp, MD
Section Editor
Martin M LeWinter, MD
Deputy Editors
Brian C Downey, MD, FACC
Diane MF Savarese, MD


Malignant involvement of the pericardium is detected in 1 to 20 percent of cancer cases in autopsy studies [1,2]. Direct involvement of the myocardium is much less frequent, either by metastatic or primary tumors [3,4]. In two large autopsy series [2,5], the incidence of any cardiac involvement was 11 and 12 percent, respectively. Of these, 76 percent had pericardial involvement, and 34 percent had an effusion [2].

The most common metastatic tumor involving the pericardium is lung cancer; others include breast and esophageal cancer, melanoma, lymphoma, and leukemia. Although AIDS-related Kaposi's sarcoma (KS) has been an important cause of neoplastic pericardial disease, the incidence of KS has declined dramatically since the advent of potent antiretroviral therapy. (See 'Etiology and pathogenesis' below and "AIDS-related Kaposi sarcoma: Clinical manifestations and diagnosis", section on 'Epidemiology and risk factors' and "Cardiac and vascular disease in HIV-infected patients", section on 'Pericardial disease'.)

Here we will discuss the presentation and management of pericardial disease associated with malignancy. An overview of the etiology of pericardial disease, and the clinical presentation, diagnosis and management of constrictive/restrictive pericardial disease related to cancer or its treatment is presented elsewhere. (See "Etiology of pericardial disease" and "Constrictive pericarditis".)


Malignant involvement of the pericardium can be manifested as pericarditis, pericardial effusion, cardiac tamponade, or pericardial constriction (constrictive pericarditis).

Pericarditis — Pericarditis is an acute inflammatory process characterized clinically by chest pain, pericardial friction rub, and widespread saddle-shaped or concave up ST segment elevation on the electrocardiogram (ECG) (waveform 1). At least two of these features, with or without an accompanying pericardial effusion, should be present to make the diagnosis. The chest pain is characteristically pleuritic, radiates to the trapezius ridge, and is worse in the supine position. These factors help to differentiate it from pain due to myocardial ischemia. (See "Acute pericarditis: Clinical presentation and diagnostic evaluation".)

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Literature review current through: Nov 2017. | This topic last updated: Dec 07, 2017.
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