Pericardial Effusion as an Early Manifestation of Anterior Mediastinal Tumor in a

Young Adult: a Case Report

Background
Pericardial effusion needs to get diagnosed early in light of their life-threatening
condition, such as cardiac tamponade, and malignancy become the second commonest
cause of it. However, it is uncommon for pericardial effusion become the primary feature
for undiagnosed malignancy and there are still very few reported similar cases for this.

Case Illustration and Discussion

A 22-year-old athletic male presented to the emergency room with dyspnea, chest pain,
and cough. He used to play basketball and soccer every week without any complaint. On
physical examination blood pressure was 90/70 mmHg and heart rate was 103 bpm.
Echocardiogram showed a severe pericardial effusion with impedning taponade also an
aorta and main pulmonary artery compression due to the tumor mass which makes his
haemodynamic unstable. CT scan confirmed the presence of an anterior mediastinal
tumor, pericardial effusion (3,7cm density), lung metastasize, ascites, pleural effusion
and congestive liver disease. An emergent pericardiocentesis was performed; 300 mL of
haemorrhagic fluid was drained. Patient were directly referred for fine needle aspiration
biopsy because suspicion for malignancy. Before the result came out, patient died due to
massive recurrence of pericardial effusion and causing cardiac tamponade.

Malignancy must be considered especially for patients undergo recurrent pericardial

effusion and other causes are unlikely. Emergent pericardiocentesis for him was the right
choice, although the prognosis such cases are poor with high rates of recurrence.
Suspicious for malignancy and unstable haemodynamic due to compression of aorta and
main pulmonary artery worsen the prognosis.

Conclusion
Anterior mediastinal tumor causing pericardial effusion, as in our case, is a rare
presentation with insufficient report regarding the main treatment approach. Further
information from similar case reports are needed because currently no guideline on the
most appropriate management for pericardial effusion and so the decision is very patient-
physician dependent.

Keywords
Pericardial effusion; pericardiocentesis; cardiac tamponade; anterior mediastinal tumor;
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