Malignant Pericardial Effusion Secondary to Mucoepidermoid Carcinoma of the Parotid Gland

摘要

A 42 year old female presented with worsening shortness of breath of one month duration accompanied by cough and hemoptysis for 3 weeks, and significant weight loss.Physical examination revealed mild to moderate respiratory distress, tachycardia, a left parotid gland mass, bilateral cervical lymphadenopathy and normal heart sounds. A diagnosis of malignant hemorrhagic pericardial effusion secondary to metastatic mucoepidermoid carcinoma of the parotid gland was made by CT scan, echocardiography, fine needle aspiration of the parotid mass and cytological examination of the pericardial effusion. Pericardiocentesis resulted in a remarkable and prolonged improvement in patient's symptoms. We report a rare case of malignant pericardial effusion secondary to mucoepidermoid carcinoma of the parotid gland. Introduction A large symptomatic pericardial effusion can be the initial presentation of an unrecognized underlying malignancy. Four cases of parotid carcinoma with pericardial involvement (only one of the mucoepidermoid variant) have been previously sited in the literature. We report an unusual case of malignant pericardial effusion secondary to metastatic mucoepidermoid carcinoma of the parotid gland in a patient presenting with worsening shortness of breath, weight loss and parotid swelling. The diagnosis was made by CT scan, echocardiography and fine needle aspiration of the parotid mass. Pericardiocentesis resulted in remarkable improvement in patient's symptoms. Case Report A 42 year old female presented with worsening shortness of breath of one month duration accompanied by cough and hemoptysis for 3 weeks. In addition, she had also lost 60 lbs of weight over the last eleven months. She denied fever, paroxysmal nocturnal dyspnea, leg swelling, loss of appetite, or contact with TB patients. The Past medical history included; type II Diabetes Mellitus, bipolar disorder, and she had discontinued all her meds 9-10 months ago. Her social history included; an admission for cocaine abuse, a smoking history of 2 packs of cigarettes daily for 10 years, with a history of alcohol abuse. Physical examination revealed the following pertinent findings; Temperature of 98.2 F, pulse rate was 129 bpm, breathing at 24 breath/min, blood pressure of 155/90, O2 saturation was 97% on room air. She was in mild to moderate respiratory distress, with a 2.5 x 3 cm soft fluctuant left parotid mass, and distant normal heart sounds.Subsequent workup was positive for the following: a chest x ray revealed right upper lobe Interstitial infiltrate. A CT scan of the neck and chest showed two necrotic masses in the left parotid gland (1.4 and 1.3 cm) with enlarged lymphadenopathy bilaterally, extending from the mandible through the supraclavicular region, right upper lobe infiltrate, and right pleural effusion, with a large pericardial effusion. The latter was confirmed by a 2 D Echocardiogram which showed neither tamponade nor structural heart disease. TB was ruled out. A Fine Needle Aspirate from the left parotid mass showed poorly differentiated mucoepidermoid carcinoma (Figure 1).