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Pericardial Effusion Prevention — SCE Medical Oncology MCQ

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ModerateLung CancerPericardial Effusion PreventionSCE Medical Oncology

A 58-year-old man with NSCLC is diagnosed with malignant pericardial effusion causing cardiac tamponade. After emergency pericardiocentesis, his oncologist considers long-term pericardial management. What are options to prevent reaccumulation?

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Correct answer: E — Pericardial window (surgical or percutaneous), intrapericardial sclerotherapy (bleomycin/cisplatin), or indwelling pericardial catheter — to prevent recurrence after initial drainage

Malignant pericardial effusion recurs in approximately 40-70% after simple pericardiocentesis alone. Prevention options: (1) surgical pericardial window (subxiphoid or VATS — allows continuous drainage into pleural/peritoneal space), (2) percutaneous balloon pericardiotomy, (3) indwelling pericardial catheter (analogous to IPC for pleural effusion), (4) intrapericardial sclerotherapy (bleomycin, cisplatin, thiotepa — ~70% control rate). Choice depends on prognosis, surgical fitness and local expertise.

Reference: ESMO 2024 Oncological Emergencies; ESC Pericardial Disease Guidelines