Echographic characteristics of pericardial diseases in children with cancers and hematological cancers

Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, Ministry of Health of Russia, Moscow Pericardial effusion may accompany malignant disease or be its first obvious clinical manifestation. The clinical interpretation of the presence and amount of pericardial effusion remains a subject for further study. Objective. To determine the incidence of pericardial diseases and their possible prognostic value in children and adolescents with cancers and hematological cancers. Subjects and methods. A total of 312 patients with cancers and hematological cancers were observed during the active development of the disease. Examinations were additionally made in 114 children and adolescents who had been admitted to the intensive care unit (ICU), including 53 patients (Group 1) with a fatal outcome and 61 patients (Group 2) who had been transferred from ICU to general wards after relief of life-threatening conditions. During the remission period, 253 children were examined at the rehabilitation stage. The diagnosis of a pericardial condition was based on ultrasound. Results. Among the 312 patients outside the ICU with an actively ongoing cancer process, pericardial effusion was detected in 79 (25.3%); out of them, 35 (44.3% of all patients with effusion) were found to have minimal effusion. Fifteen of these 35 patients had effusion in the presence of a systemic infection. Moderate effusion was recorded in 15 patients (19% of all patients with exudative pericarditis). There were no neoplastic cells or infectious agents in the pericardial fluid. Twenty-nine (36.7%) patients had a large effusion with the separation of epi- and pericardial layers in systole and diastole with an echo-free space over the anterior surface of the heart; in 15 of them, it was concurrent with a plural effusion. Small and moderate effusions did not affect the condition of patients. Large, long-lasting, and polyserositis-associated effusions were correlated with an unfavorable outcome. The volume of effusion, which was equal to or greater than that of the left ventricle and often concurrent with polyserositis, is regarded as critical, threatened by cardiac tamponade, was observed only in the group of children with a fatal outcome. At the stages of rehabilitation, pericardial effusion was rarely detected; it was minimal and did not affect prognosis. Conclusion. Effusive pericarditis frequently accompanies cancers. Recurrent large-volume effusions that are concurrent with those into other cavities and life-threatening are unfavorable. They are rarely associated with infection and suggest the underlying disease has a critical course, as well as they can be regarded as paraneoplastic.

pediatrics, oncology, pericarditis, children, leukemia, solid tumors, diagnosis, prognosis