The invasive mucinous adenocarcinoma of the lungs (LIMA) is an uncommon histological subtype of the mucinous adenocarcinoma. In this article, we present the case of a patient with a very high cardiovascular risk profile, diagnosed with LIMA, pericardial tamponade due to secondary dissemination, and pulmonary embolism, whose management rouses many challenges. Despite receiving the correct anticoagulant and antiaggregant therapy, our patient developed repeated acute major cardiovascular events leading to a fatal outcome. To gather additional information on LIMA and the above cluster of pathologies, we performed the first research of the international medical literature for scientific articles published in the last eight years on PubMed, ResearchGate, Clarivate, and Google Scholar. As the first literature research failed to identify any case similar to our patient, we performed a second study of the same databases for subjects with lung adenocarcinoma instead of LIMA and the same comorbidities, and we found 10 cases. LIMA is a less frequent type of adenocarcinoma, with polymorphic radiologic appearances on the chest computed tomography, frequently mimicking pneumonia, and thus delaying the diagnosis and therapy. It has a worse prognosis and higher mortality than the common adenocarcinoma, but information on its secondary dissemination and complications is still required.

Aortic dissection is rare and often presents with atypical symptoms. We describe a case of a patient with acute aortic dissection involving the coronary arteries, complicated by pericardial tamponade, and discuss findings using point-of-care ultrasound, diagnostics, and treatment of this condition.

Fungal pericarditis, a rare clinical presentation primarily observed in post-cardiothoracic surgery and immunocompromised patients, requires prompt recognition and effective treatment involving antifungal medications and surgical drainage. We report the case of a 40-year-old female initially diagnosed with infective endocarditis who progressed to cardiac tamponade. Timely surgical drainage significantly improved the patient\'s clinical status and revealed fungal pericarditis through pathological analysis. This case highlights the importance of considering the diagnosis of fungal pericarditis even in the absence of prior cardiothoracic surgical intervention and emphasizes the crucial role of both intravenous antifungal therapy and surgical drainage in its treatment.

BACKGROUND: Nowadays, percutaneous procedures are expanding in use, and this comes with complications associated with the procedure itself. Cardiac tamponade is rare but may be life threatening since it can involve hemodynamic instability. It is known that after pleural effusion during a percutaneous procedure, pericardiocentesis should be used as drainage of the cavity. However, that does not achieve hemostasis in some cases, and in those patients who are hemodynamically unstable, a sealing agent to promote hemostasis might be useful, like thrombin.
METHODS: We present a case report of 89-year-old patient with history of melanoma undergoing treatment with pembrolizumab, who attended the emergency department referring chest pain (intensity 5/10) and palpitations that have lasted hours. He had TnTUs 554/566 ng/L and an echocardiogram that showed dilated right chambers, hypertrophy and global hypokinesia of the left ventricle, increased filling pressures of the left ventricle and pulmonary hypertension. Myocarditis associated with pembrolizumab was suspected, so high dose steroids were initiated and endomyocardial biopsy was conducted, resulting in iatrogenic cardiac tamponade. To determine the etiology of the suspected myocarditis, an endomyocardial biopsy was performed. Unfortunately, an intraprocedural complication arose: pleural effusion resulting in iatrogenic cardiac tamponade, leading to hemodynamic instability. It required immediate pericardial drainage via subxiphoid puncture, obtaining a 550 mL hematic debit. Clinical manifestations raised suspicion of tamponade, prompting a bedside echocardiogram for a definitive diagnosis. Despite these efforts, the patient remained hemodynamically unstable, and due to the elevated surgical risk, intrapericardial thrombin was employed to achieve successful hemostasis.
CONCLUSIONS: Cardiac tamponade is a life-threatening condition that can sometimes be induced iatrogenically, resulting from percutaneous interventions. Despite limited evidence regarding this therapeutic strategy, in patients experiencing iatrogenic cardiac tamponade with hemodynamic instability and high surgical risk, the administration of intra-pericardial thrombin could be contemplated.

Systemic lupus erythematosus (SLE) is a chronic inflammatory disease that can affect the heart, lungs, and other organs. We describe the case of a 36-year-old female patient who first presented with non-specific symptoms before receiving a diagnosis of SLE, along with initial evidence of pleural effusion and cardiac tamponade. Heart tamponade, which is characterized by fluid accumulation in the pericardial space, is an unusual but serious side effect of SLE. Pleural effusion, or an accumulation of fluid in the pleural cavity, is a typical hallmark of SLE; however, it rarely manifests as the disease\'s initial symptom. The early identification and diagnosis of these cardiovascular symptoms of SLE is critical for timely intervention and improved patient outcomes. This case report highlights the significance of considering SLE when performing a differential diagnosis for patients who have cardiovascular symptoms, particularly when pleural effusion and cardiac tamponade are present. To increase awareness and knowledge of these uncommon presentations of SLE, more investigations and comprehension of the underlying pathophysiology are required.

UNASSIGNED: Alcohol septal ablation (ASA) can be recommended for patients with drug-refractory hypertrophic obstructive cardiomyopathy (HOCM). Recently, percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) was reported as a safe and effective treatment for HOCM.
UNASSIGNED: We present a case report of pulseless electrical activity (PEA), cardiac arrest, and pericardial tamponade occurring post-PIMSRA. We performed PIMSRA for the patient with HOCM after failed ASA. Two hours post-PIMSRA, transthoracic echocardiography (TTE) revealed that the hypokinetic basal intraventricular septal (IVS) thickness increased with aggravation of systolic anterior motion of the mitral valve. After the occurrence of subsequent PEA cardiac arrest, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support was provided. With sinus rhythm restoration and blood pressure stabilization after ECMO removal, the patient had pericardial tamponade on Day 3 post-PIMSRA. After excluding apparent myocardial perforation and draining haemorrhagic effusion under TTE guidance, her symptoms and haemodynamic status improved. She was asymptomatic at her one-year follow-up. The left ventricular outflow tract gradient (LVOTG) at rest and the thickness of the basal IVS reduced to 5 mmHg and 12 mm, respectively.
UNASSIGNED: We assumed that the main causes of PEA cardiac arrest and pericardial tamponade in our case were ablation-related tissue oedema at the basal IVS and blood leakage possibly related to puncture haemorrhage, respectively. While waiting for myocardial oedema to resolve, ECMO was applied as a bridge-to-recovery therapeutic approach. Pericardiocentesis is a strategy for the emergency drainage of pericardial effusion. It is essential to distinguish life-threatening complications with TTE for management planning post-PIMSRA.

UNASSIGNED: The occurrence of a large pericardial effusion is not a commonly noted adverse event associated with pembrolizumab and our report demonstrates that a rapid development can be diagnosed with close monitoring and triage to acute medical settings.
UNASSIGNED: Pembrolizumab is an immune checkpoint inhibitor used in various types of cancers. Pericardial tamponade is a rare side effect reported in only very few case reports. Early recognition and therapeutic intervention is vital in all cases. We report a case of a 54-year-old male with Stage 3 lung adenocarcinoma who developed cardiac tamponade secondary to pembrolizumab and subsequently required pericardial window.

Increased vaccination rates and better understanding of influenza virus infection and clinical presentation have improved the disease\'s overall prognosis. However, influenza can cause life-threatening complications such as cardiac tamponade, which has only been documented in case reports. We searched PubMed/Medline and SCOPUS and EMBASE through December 2021 and identified 25 case reports on echocardiographically confirmed cardiac tamponade in our review of influenza-associated cardiac tamponade. Demographics, clinical presentation, investigations, management, and outcomes were analyzed using descriptive statistics. Among 25 cases reports [19 adults (47.6 ±15.12) and 6 pediatric (10.1 ± 4.5)], 15 (60%) were females and 10 (40%) were male patients. From flu infection to the occurrence of cardiac tamponade, the average duration was 7±8.5 days. Fever (64%), weakness (40%), dyspnea (24%), cough (32%), and chest pain (32%) were the most prevalent symptoms. Hypertension, diabetes, and renal failure were most commonly encountered comorbidities. Sinus tachycardia (11 cases, 44%) and ST-segment elevation (7 cases, 28%) were the most common ECG findings. Fourteen cases (56%) reported complications, the most common being hypotension (24%), cardiac arrest (16%), and acute kidney injury (8%). Mechanical circulatory/respiratory support was required for 14 cases (56%), the most common being intubation (9 cases, 64%). Outcomes included recovery in 88% and death in 3 cases. With improving vaccination rates, pericardial tamponade remains an infrequently encountered complication following influenza virus infection. The complicated cases appear within the first week of diagnosis, of which nearly half suffer from concurrent complications including cardiac arrest or acute kidney injury. Majority of patients recovered with timely diagnoses and therapeutic interventions.

Thoracic trauma often results in immediate or delayed hemorrhage. There are few cases of purulent pericarditis with pericardial tamponade reported in the literature. If a devastating complication develops several weeks following blunt thoracic trauma, the causal relationship with the thoracic trauma event is less evident. As such, accurate diagnosis and subsequent effective treatment implementation is likely to be delayed. Herein, we present the case of a 46-year-old male patient with delayed purulent pericarditis that led to cardiac tamponade 2 weeks after the initial trauma.

This case report involves a 93-year-old female patient with atrioventricular block and suffered right ventricular free wall perforation during installation of Micra Leadless Pacemaker (MLP). Pericardial tamponade occurred shortly, and we adopted pericardial catheter drainage as the primary emergency treatment. Considering the patient\'s physical conditions and leveraging the special treatment facilitates of the Intensive Care Unit (ICU), we tried a new emergency treatment approach. After putting the patient under intravenous anesthesia (no cardiac arrest), we made a small intercostal incision and performed bedside minimally invasive repair of right ventricular free wall perforation. It should be noted that ultrasound played a key role in pinpointing the breach and intraoperative guidance. We first used contrast-enhanced ultrasound (CEUS) to locate the breach. Then guided by bedside ultrasound, we accessed the perforation with the minimum incision size (5 cm). Our experience in this case may serve as a good reference in the emergency treatment for right ventricular free wall perforation.