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ARTICLE |

Management of Malignant Pericardial Effusion and Tamponade

Oliver W. Press, MD, PhD; Robert Livingston, MD
JAMA. 1987;257(8):1088-1092. doi:10.1001/jama.1987.03390080078037.
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THE OPTIMAL management of neoplastic cardiac tamponade has been controversial, with ardent proponents of pericardiocentesis (with or without sclerotherapy),1-3 surgical decompression,4-8 and radiation therapy9-11 as primary therapeutic modalities. In the eight years since this oncologic emergency was last reviewed in this journal,12 several informative therapeutic trials have been reported that warrant a reappraisal of the recommended interventions for this condition.

Epidemiology  Although neoplastic involvement of the heart is commonly regarded as a rare condition, a compilation of autopsy series suggests that 3.4% (642/19130) of general autopsies13-18 and 11.6% (1280/11078) of cancer autopsies13-21 demonstrate cardiac metastatic disease. Of 770 cases of cardiac metastases for which adequate information was reported, 533 (69.2%) had involvement of the pericardium.13-16,19,21 The majority of cases were clinically insignificant; however, 29% of such patients developed symptoms referable to pericardial metastases and 16% developed cardiac tamponade.22 Pericardial lesions were either

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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