Pericardial effusion can be the first sign of occult neoplasia, such as prostate cancer, even in patients without major risk factors for poor prognosis.
NSAID-refractory pericardial effusion in aortic stenosis warrants malignancy evaluation; this case leaves open systematic screening recommendations.
We present the case of a 59-year-old patient with severe aortic stenosis, asymptomatic mild to moderate pericardial effusion and no major risk factors for poor prognosis. He underwent four-week course of non-steroidal anti-inflammatory drugs (ibuprofen 600 mg TID) with no improvement of the effusion. After complete diagnostic work-up and examination, we discovered that he had a prostate cancer with bone metastasis. On the bone scintigraphy, there was particular involvement of ribs and sternum. We decided to treat our patient with an association of docetaxel and hormone therapy, after six months we observed a reduction in the pericardial effusion. Even in the presence of a patient without risk factor of poor prognosis, pericardial effusion can be the first sign of occult neoplasia.
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D’Amato et al. (2017) studied this question.
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