The Management of Malignant Pericardial Effusions

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Abstract
The accumulation of fluid in the potential space between serosal membranes may develop in 5% to 50% of patients with disseminated malignant disease.1Malignant pericardial effusion is particularly important because of its insidious clinical expression and the life-threatening potential of cardiac tamponade. Two mechanisms for the production of pericardial effusion that have been suggested are (1) tumor implantation on serosal surfaces leading to exudation of fluid, and (2) obstruction to lymphatic flow by mediastinal or hilar neoplastic infiltration causing transudation of fluid within the pericardial sac.2In the experimental model, lymph flow proceeds from the endocardial to the epicardial surface, and pericardial effusion is an accumulation of fluid exuding from the visceral pericardium (epicardium). Mere obstruction of the mediastinal lymphatic system draining the heart is inadequate to produce pericardial effusion, and additional ligation of the coronary sinus and the anterior coronary veins is essential. These studies have two

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