[Cardiac tamponade as first sign of papillary thyroid carcinoma].

Twenty percent of cases of cardiac tamponade are of malignant etiology, according to autopsy series. The most common cause is lung cancer, followed by breast and esophageal cancer, melanoma, lymphoma, and leukemia. Papillary thyroid carcinoma is a very rare cause of malignant cardiac tamponade, and is even more exceptional as the first sign of the disease. A 56-year-old female patient with nodular goiter since childhood who 30 years earlier had undergone left hemithyroidectomy for a 4.5 cm× 4.5 cm toxic nodule is reported here. A pathological study revealed benign disease and nodular hyperplasia. Secondary hypothyroidism was subsequently treated with levothyroxine. The patient attended the emergency room of her reference hospital reporting the occurrence during the previous month of asthenia, anorexia, weight loss, malaise, generalized pain, a progressive decrease in urine output, edema in the lower limbs, and progressive dyspnea in the preceding weeks with a sudden worsening to dyspnea at rest associated with dizziness and hypotension. Chest X-rays showed an increased cardiothoracic ratio with bilateral pleural effusion. A CT scan of the chest revealed pleuropericardial effusion (Fig. 1). The patient was referred to Hospital Central, where she was admitted with tachycardia of 115 bpm, tachypnea of 28 rpm, and poor perfusion. An electrocardiogram showed sinus rhythm with electric alternance, and an echocardiogram revealed pericardial effusion surrounding the cardiac silhouette. Pericardiocentesis was performed, with abundant fluid being drawn. The initial response was good, but a sudden impairment occurred two hours later, leading to cardiorespiratory arrest which did not respond to resuscitation maneuvers.