Pericardial effusion in lung cancer - The role of pericardioscopy, biopsy and fenestration

Background and Objectives. Involvement of the pericardium by metastases of bronchogenic carcinoma is often underestimated. Due to our earlier experience that showed high incidence of pericardial involvement in lung cancer, we initiated the following study. Material and Methods. In 72 patients who had bronchogenic carcinoma and concomitant pericardial effusion, we performed pericardioscopy with biopsy and creation of a pericardial window. Under general anesthesia, the pericardium is dissected through a subxiphoid approach. After aspiration of all liquid, a mediastinoscope is inserted for inspection and biopsies. A section of pericardium is excised for histologic examination. The window thus created is left open, closing only the skin. Results. The effusion ranged from 300 ml to 1400 ml. It was hemorrhagic in 39 patients, clear in 33. Metastases were found in 50 of the 72 patients (69.5%). Conclusions. Symptomatic pericardial involvement in patients with bronchogenic carcinoma is not rare. Definitive diagnosis and effective palliative treatment are best achieved by biopsy and creation of a pericardial window. The complication rate is low.