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Seorang penderita kanker paru dengan manifestasi efusi perikardium: Laporan kasus



Abstract

Background: Based on WHO data, lung malignancy is the most common cause of death in patients with cancer. On the other hand, 10-20% of metastasis involves pericardium.  Pericardial effusion is associated with variety of underlying heart diseases, malignancies, infections and complications of cardiovascular procedures. However, in some cases, MPE may manifest to cardiac tamponade which cause collapse of cardiovascular system and will eventually lead to death.

Case description: We reported 51 years old male patient with chief complain of shortness of breath especially when lying down. Patient has history of the same complaints and had done pericardiocentesis in the past. Patient were now hospitalized with severe pericardium effusion post-cardiocentesis and stage IV pulmonary malignancy. Biopsy showed that the patient had squamous cell carcinoma. Two weeks after the lung biopsy, patient’s condition worsened and patient eventually passed away. Patient was planned to have paclitaxel-carboplatin chemotherapy after biopsy. Pericardium effusion is associated with cardiac metastases, which most often originate from lung malignancy. There are four mechanism of pericardial metastasis, such as direct extension, through blood vessel, lymphatic vessel and through intracavity diffusion either through cava vein or pulmonary vein. Cardiac tamponade is a life-threatening complication caused by accumulation of excessive fluid which cause extracardial compression and haemodynamic instability. Therefore, pericardiocentesis is needed as an emergency and life-saving procedure.

Conclusion: Chemotherapy may increase the survival rate of patients with MPE.

 

Latar belakang: Data WHO menunjukan bahwa kanker paru merupakan penyebab kematian utama akibat keganasan dimana angka insiden keganasan yang melibatkan metastasis pada pericardium sekitar 10-20%. Efusi perikardium sering dihubungkan dengan berbagai macam penyakit seperti penyakit jantung, keganasan, infeksi dan sebagai komplikasi prosedur tindakan kardiovaskuler. Pada beberapa kasus metastasis jantung dapat bermanifestasi menjadi tamponade jantung sehingga menyebabkan kolaps sistem kardiovaskuler yang dengan cepat dapat menyebabkan kematian.

Deskripsi kasus: Kami melaporkan seorang pasien laki-laki berusia 51 tahun dengan keluhan sesak nafas terutama berbaring. Pasien sudah mengalami keluhan yang sama berulangkali dan telah dilakukan perikardiosintesis. Saat ini pasien dirawat dengan efusi perikardium berat post-kardiosentesis dengan keganasan paru stadium IV dengan hasil biopsi karsinoma sel skuamosa. Pasien mengalami perburukan dan meninggal dua minggu setelah biopsi paru. Seharusnya setelah dilakukan biopsi paru, pasien direncanakan untuk menjalani kemoterapi paclitaxel-carboplatin. Efusi pericardium sering dikaitkan dengan proses metastase jantung dimana penyebabnya paling banyak berasal dari keganasan pada paru. Penyebaran tumor ke jantung dapat melalui empat jalur yaitu secara langsung (direct extension), melalui pembuluh darah, melalui sistem limfe dan melalui difusi intrakavitas baik melalui vena kava maupun vena pulmonaris. Komplikasi yang sering terjadi adalah tamponade jantung yaitu suatu kondisi mengancam jiwa yang disebabkan oleh akumulasi cairan yang terlampau banyak sehingga menyebabkan kompresi ekstrakardial dan gangguan hemodinamik yang membahayakan sehingga diperlukan perikardiosentesis sebagai tindakan emergensi.

Kesimpulan: Pemberian kemoterapi dapat memberikan peningkatan angka kesintasan pasien.

Keywords: Karsinoma sel skuamousa efusi perikardal maligna efusi pericardium

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How to Cite

Dwijayanthi, I. A. N., & Sutha, I. B. (2020). Seorang penderita kanker paru dengan manifestasi efusi perikardium: Laporan kasus. Intisari Sains Medis, 11(2), 590–596. https://doi.org/10.15562/ism.v11i2.591
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