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Malignant Pericardial Effusion — EECC MCQ

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ModeratePericardial DiseaseMalignant Pericardial EffusionEECC

A 60-year-old woman with metastatic breast cancer develops progressive breathlessness. Echocardiography shows a large pericardial effusion with early echocardiographic signs of tamponade (RV diastolic collapse, IVC plethora). She is haemodynamically stable with BP 110/70 mmHg. What is the recommended management?

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Correct answer: D — Pericardiocentesis with extended catheter drainage and consideration of intrapericardial therapy or pericardial window to prevent reaccumulation

Malignant pericardial effusion is common in advanced cancer (breast, lung, lymphoma). In the presence of echocardiographic signs of tamponade (even if haemodynamically stable — this is 'echocardiographic tamponade' that may progress rapidly), pericardiocentesis with extended catheter drainage (typically 24-72 hours) is recommended. To prevent reaccumulation (which occurs in 40-70% of cases), options include: intrapericardial instillation of sclerosing agents or chemotherapy, surgical pericardial window (subxiphoid or thoracoscopic), or systemic treatment of the underlying malignancy. The 2025 ESC Pericarditis Guidelines recommend pericardiocentesis for suspected neoplastic or bacterial pericarditis (Class I for diagnosis and treatment).

Reference: ESC (2025): Guidelines for Myocarditis and Pericarditis