B49-36 The Heart of the Matter: Cardiac Tamponade as an Atypical Presentation of Gallbladder Cancer

Abstract Introduction/Background This case report describes a 58-year-old male with no past medical history who presented with shortness of breath and cough, ultimately diagnosed with metastatic gallbladder adenocarcinoma, notable for its unusual presentation of recurrent pericardial effusions. Case Presentation ​​A 58-year-old male with no significant past medical history presented with progressive dyspnea and cough. Initial workup revealed a left-sided pleural effusion, mediastinal mass, and widespread metastatic disease, including osseous lesions and a right lung nodule. Biopsies of bone and lymph nodes indicated poorly differentiated carcinoma.An echocardiogram showed a 1250 cc circumferential pericardial effusion causing profound cardiac tamponade and right ventricular compression, leading to near-cardiac arrest during induction for pericardiocentesis. Histopathology and immunohistochemistry (CK7 positive, CDX2 positive) along with elevated CA19-9 confirmed metastatic gallbladder adenocarcinoma.Despite a pericardial window, the patient experienced recurrent large volume pericardial effusions (850 cc) and recurrent pleural effusions, requiring a PleurX catheter for palliative management. This case highlights an atypical presentation of metastatic gallbladder adenocarcinoma with significant and recurrent pericardial effusions. Conclusion/Discussion This case highlights an atypical presentation of metastatic gallbladder adenocarcinoma, particularly the significant and recurrent pericardial and pleural effusions. While pericardial effusions are more commonly associated with lung cancers, this patient’s primary malignancy was confirmed to be gallbladder adenocarcinoma, emphasizing the importance of a comprehensive diagnostic workup in cases with unusual clinical findings. This abstract is funded by: None