We report the case of a 60-year-old woman with a history of osteoporosis treated with weekly bisphosphonates who came to the emergency department due to postpandrial gastric plenishment, dyspepsia and nausea for 4 days.
Physical examination revealed mild jugular engorgement and hepatomegaly of 3 cm. Chest X-ray showed grade II cardiomegaly.
suspected abdominal pain probably secondary to gastropathy due to NSAI and unrelated heart failure was admitted to internal medicine for study.
On the night of admission, progressive clinical deterioration with hypotension, poor peripheral perfusion, and signs of right heart failure were observed.
The ECG showed sinus tachycardia at 110/min, generalized microvoltage and electrical alternation.
Emergency ultrasound scan confirmed the suspicion of pericardial effusion with cardiac tamponade.
A pericardiocentesis was performed, improving the clinical condition and stable evacuation for several days.
Subsequent routine controls confirmed the persistence of pericardial effusion and pericardiectomy with pericardiectomy window was performed.
The study of the pericardial fluid was compatible with exudate, where metastatic cells of adenocarcinoma were isolated.
With the clinical judgment of peribronchial effusion as metastatic bronchoalveolar lavage was performed extension study with bronchial lavage and highlighted the presence of bilateral pleural effusion, multiple mediastinal lymphadenopathies and normal lumbar images reported in the spine.
There was an increase in the following markers: CEA 33.62 ng/ml (0-4.7) Cifra 21: 14.92 ng/ml (0-3) CA 15.3: 56.79 U/ml (0-37) CA 19.9
With the diagnosis of a tumor of unknown origin of probable pulmonary origin, given its location, or breast, given the sex of the patient and the high prevalence of this tumor, it was decided not to perform further diagnostic tests and paclitaxel chemotherapy was initiated.
Once the clinical situation was established, the patient was discharged with a pericardial window and pericardial drainage.
One week after discharge, the patient was readmitted for clinical worsening with signs of right heart failure.
An echocardiogram showed tamponade due to malfunction of the pericardiac window probably secondary to clots and fibrosis.
The patient was assessed by the cardiovascular surgery service that disregards surgical intervention.
The patient was there two days later.
