Case Presentation:
A 29‐year‐old man with a medical history of melanoma was being treated in the hospital for radiation‐induced esophagitis. He was first diagnosed with melanoma in the axillary region 5 years ago and since 1 year had developed metastases to the brain, lungs, liver, and spine. He had been treated with chemotherapy and radiation a year ago and again received radiotherapy recently for cord compression, after which he had developed the present episode of esophagitis. On examination, he was emaciated and tachycardic. His labs revealed pancytopenia. He started showing signs of sepsis and was started on antibiotics. On day 5 of hospitalization, he became lethargic and was short of breath. He had an elevated jugular venous pressure on examination and became hypotensive. An echocardiogram revealed a large pericardial effusion with “swinging” heart and collapse of the right atrium and ventricle, diagnostic of cardiac tamponade. A mass was visualized in the pericardial space along with formed elements consistent with metastatic melanoma. The patient was taken to the operating room, where 650 mL of hemorrhagic fluid was drained, and he received a pericardial window. The patient's postoperative course was complicated by septic shock. The patient's condition continued to deteriorate, and he died on day 21 of hospitalization.
Discussion:
The common malignancies metastasizing to the heart are lung, lymphoma, breast, leukemia, stomach, melanoma, liver, and colon in decreasing order of frequency. Most of the reported cases of metastatic melanoma to the heart are intracavitary metastases. Singh and Krishnan described one of the first cases of malignant melanoma causing cardiac tamponade in 1967. Dreno et al. described a case of a 50‐year‐old man who developed cardiac tamponade after receiving chemotherapy for metastatic melanoma. Cree and colleagues reported a case of uveal melanoma in which the patient died because of cardiac tamponade. Very few such cases have been described in the literature thus far. We describe a case of malignant melanoma with metastasis to the heart that was unmasked by cardiac tamponade.
Conclusions:
Pericardial effusion with tamponade should be in the differential diagnosis of patients with malignant melanoma presenting with signs of cardiopulmonary compromise. Early recognition by hospitalists is critical, as it can cause rapid decompensation and death.
Author Disclosure:
P. Chandra, Maimonides Medical Center, resident physician; A. Chandra, Good Samaritan Regional Medical Center, employment.