Malignant Pericardial Effusion

The clinical symptoms of cardiac tamponade associated with malignancy are reviewed, and the importance of these symptoms in relationship to treatment decisions are discussed. The clinical findings of tamponade and the echocardiographic findings have been correlated. The approach to treatment of cardiac tamponade has been summarized. The various surgical techniques, including pericardial window formation, subxyphoid drainage, and thoracoscopy and video-assisted thoracoscopy, are discussed and the relative benefits of the various procedures have been presented. Results of the less invasive percutaneous balloon pericardiostomy procedure have also been reviewed, and updates of recent small series have been included. Medical management of malignant pericardial effusion with small-bore tube drainage followed by sclerosis has been reviewed, and the results of recent series reporting the effectiveness of various sclerosing agents, including tetracycline, doxycycline, and bleomycin, have been compared.