Treating a Metastatic Pericardial Tumor

Figures

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  Figure 1. Transthoracic Echocardiogram (Prepericardiocentesis) Showing Early Signs of Tamponade Physiology (A) Mitral respiratory inflow variation >25%. (B) Tricuspid respiratory inflow variation >40%. (C) Plethoric inferior vena cava, >2 cm in diameter with <50% collapse with inspiration.

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  Figure 2. Transthoracic Echocardiogram Apical 4-Chamber View (Intraprocedural) (A) Diastolic compression of the right ventricle (RV) and right atrium (RA). A pericardial effusion is seen anterior to the right ventricle and over the apex (∗) with a loculation (open arrow) separating these 2 pockets of fluid. (B) Percutaneous pericardiocentesis showing the injection of agitated saline (∗) to confirm catheter placement. (C) Postpericardiocentesis showing a small residual pericardial effusion (∗) and relieved compression of the RV and RA.

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  Figure 3. Transthoracic Echocardiogram (Postpericardiocentesis) Confirming Pericardial Constriction (A) Mitral respiratory inflow variation of 25%. (B) Tricuspid respiratory inflow variation >40% even after pericardial pressure was relieved by removal of pericardial fluid. (C) Diastolic hepatic vein flow reversal in expiration, a specific finding for pericardial constriction.

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  Figure 4. Pericardial Tethering Detected by Demonstration of Annulus Reversus, a Specific Finding for Pericardial Constriction (A) Mitral annular medial e′ velocity (11.9 cm/s) greater than (B) lateral e′ velocity (8.8 cm/s). (C) Greater longitudinal strain of the medial portion of the mitral annulus compared with the lateral portion.

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  Figure 5. Cardiac Magnetic Resonance T1 Spin Echo (A) Before chemotherapy showing extensive pericardial involvement (open arrows). (B) After 10 cycles of folinic acid, 5-fluorouracil, irinotecan, and oxaliplatin showing near resolution of pericardial tumor (open arrows).

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  Visual Summary. Case Progression in Investigative Images