Emergent pericardiocentesis successfully drained 1,000 mL of hemorrhagic fluid in a 68-year-old man with rare malignant pericardial tamponade from metastatic tongue base squamous cell carcinoma.
Case Report (n=1)
Malignant pericardial tamponade from tongue base squamous cell carcinoma is an exceptionally rare complication requiring urgent recognition, early use of point-of-care ultrasound, and prompt multidisciplinary management.
Abstract Malignant pericardial effusion from lingual squamous cell carcinoma (SCC) is exceedingly rare—among 31 reported cases of cardiac metastases in systematic reviews, only seven presented as pericardial effusion—and is often recognized late or post-mortem due to non-specific signs. Outcomes are poor, with up to 44% mortality (mostly within 30 days of admission), reinforcing the need for rapid evaluation, timely diagnosis, and early goals-of-care discussions. We present the case of a 68-year-old man with a history of P16-positive Tongue Base Squamous Cell Carcinoma (SCC) metastatic to tracheal, supraclavicular, and pleural sites, status post multiple surgeries, chemotherapy, and radiotherapy. He presented to the Emergency Department with acute dyspnea following accidental home damage to his indwelling pleural catheter and reported right-sided pleuritic chest pain for three days. Evaluation revealed tachycardia, hypoxemia, leukocytosis, elevated procalcitonin, and a new right basilar opacity, leading to a diagnosis of severe sepsis secondary to obstructive pneumonia. The patient was admitted to the Intensive Care Unit for broad-spectrum antibiotics and further evaluation. Computed Tomography Angiography (CTA) and Point-of-Care Ultrasound revealed a new pericardial effusion. Emergent pericardiocentesis by Cardiology drained 1,000 mL of hemorrhagic fluid, with cytology positive for malignant SCC cells. Colchicine was initiated to reduce pericardial inflammation. Despite intervention, his respiratory status remained precarious due to persistent bilateral effusions, progressive mediastinal metastases, and sepsis. Given refractory disease, poor functional status, and multiple life-threatening complications, including rare malignant pericardial tamponade from head and neck cancer, the patient elected comfort-directed hospice care and died peacefully within 10 days of admission. Malignant pericardial tamponade from Tongue Base SCC is an exceptional finding requiring urgent recognition and management. This case illustrates a rare oncologic trajectory in which Tongue Base SCC produced both malignant pleural and pericardial effusions culminating in cardiac tamponade. The co-occurrence of pleural catheter malfunction and septic pneumonia compounded his critical illness, emphasizing the vulnerability of patients with advanced cancer to complex oncologic and infectious complications. It emphasizes the importance of serial clinical reassessment, early use of Point-of-Care Ultrasound for rapid tamponade detection, and prompt multidisciplinary intervention. Ultimately, the integration of palliative medicine allowed alignment of treatment with patient values, ensuring dignity and comfort at the end of life. This abstract is funded by: None
Lamadrid et al. (Fri,) conducted a case report in Metastatic Tongue Squamous Cell Carcinoma with Malignant Pericardial Tamponade (n=1). Pericardiocentesis was evaluated. Emergent pericardiocentesis successfully drained 1,000 mL of hemorrhagic fluid in a 68-year-old man with rare malignant pericardial tamponade from metastatic tongue base squamous cell carcinoma.