E0707 - A Case Series of Gastric Adenocarcinoma Presenting as Cardiac Tamponade

Allison Molstad, ¹, Ushan A. Ranasinghe, MS, MD², Bret Kersting, ¹, Kavita Singh, MD^2
1Midwestern University Chicago College of Osteopathic Medicine, Downers Grove, IL; ²Swedish Hospital, Chicago, IL

Introduction: Gastric cancer is the fourth most common type of cancer worldwide and frequently presents at an advanced stage. As such, the presenting symptoms of gastric cancer may be related to sites of metastasis rather than the primary tumor. We describe two cases that presented to the same hospital within a six-month period who were found to have pericardial tamponade secondary to gastric adenocarcinoma metastasis.

Case Description/Methods: Case 1 describes a case of a 91-year-old male who presented with progressively worsening dyspnea. A bedside echocardiogram revealed large pericardial effusion with evidence of cardiac tamponade. Pericardiocentesis and formation of a pericardial window was emergently performed. Cytology revealed metastatic signet ring adenocarcinoma with gastric as the most likely origin. Case 2 describes a case of a 68-year-old female with a history of breast cancer who presented to the hospital with epigastric pain, nausea and dyspnea on exertion accompanied by chest pain upon presentation to the ED. An echocardiogram revealed a large pericardial effusion with evidence of tamponade and a pericardiocentesis was urgently performed. A CT scan noted multiple hepatic lesions that were highly suspicious for metastatic disease. She underwent interventional radiology (IR) guided biopsy of a liver lesion and the pathology was consistent with adenocarcinoma. A follow-up esophagogastroduodenoscopy (EGD) with biopsies revealed moderately to poorly differentiated gastric adenocarcinoma as the primary tumor.

Discussion: The pericardium is a rare site of metastasis for gastric adenocarcinoma and may present atypically. Subacute presentation of tamponade may mimic heart failure; thus physicians should have a lower threshold for ordering echocardiography.


Disclosures:


Allison Molstad, ¹, Ushan A. Ranasinghe, MS, MD², Bret Kersting, ¹, Kavita Singh, MD². E0707 - A Case Series of Gastric Adenocarcinoma Presenting as Cardiac Tamponade, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.