Thanks to our awesome ICU team for presenting a case of 54 yo transgender female who presented with non-specific symptoms found to have tamponade from metastatic small cell carcinoma.
- Of the many causes of cavitary lung lesions, prioritize the the possibility of necrotizing pneumonia [rapidly fatal], Tb [reduce exposure] and septic emboli from tricuspid endocarditis [may be rapidly fatal].
- Short of a formal TTE/TEE, the diagnosis of tamponade can be very tricky. A pulsus paradoxus may be falsely negative [hypovolemia, PFO], and a bedside ultrasound may miss a posterior effusion.
- Tamponade looks all the world CHF [cool extremities, elevated JVP, lower extremity edema] but is classically associated with a low BNP and improves, albeit temporarily, with fluids.
- Small Cell Carcinoma is exquisitely sensitive to chemotherapy. Even patients with metastatic disease can initially have a robust clinical response.
Here’s a diagnostic approach to cavitary lung lesions
All causes of a pericardial effusion can lead to tamponade
Pathophysiology of tamponade