SESSION TITLE: Lung Cancer Case Report Posters 3SESSION TYPE: Case Report PostersPRESENTED ON: 10/17/2022 12:15 pm - 01:15 pmINTRODUCTION: Lung cancer is the leading cause of cancer deaths in the U.S. and is broadly categorized as non-small cell lung cancer (NSCLC), comprising 80% of the cases, and small cell lung cancer (SCLC). Although common presentations include pulmonary symptoms of cough, dyspnea, and pleuritic chest pain, lung malignancies can present in a myriad of ways. Malignant pericardial effusion with tamponade physiology is an unusual initial presentation of primary lung cancer and it is associated with poor prognosis. (1)CASE PRESENTATION: A 72-year-old female with a history of depression, hyperlipidemia, hypertension, and tobacco abuse presented with a 6-week history of shortness of breath, dry cough, decreased appetite, and fatigue. With an initial diagnosis of pneumonia, she was prescribed multiple rounds of antibiotics without any improvement. On examination, she was tachycardic, tachypneic, and hypoxemic with oxygen saturation of 92% on 2 liters nasal cannula. Heart sounds were distant on auscultation, and elevated jugular venous pressure (JVP) was noted. Initial labs were unremarkable. CT angiogram of the chest demonstrated moderate pericardial effusion measuring approximately 2cm posteriorly. EKG revealed low voltage QRS with electrical alternans, and a subsequent echocardiogram revealed a large (>2cm) circumferential pericardial effusion with right ventricular diastolic collapse consistent with cardiac tamponade. The patient underwent emergent pericardiocentesis with 700cc of fluid removed. Cytology of pericardial fluid was consistent with adenocarcinoma showing malignant cells positive for MOC-31 and Ber-EP4. Furthermore, the majority of the malignant cells were TTF-1 positive, supporting adenocarcinoma of pulmonary origin. An echocardiogram before discharge showed resolution of tamponade physiology. The patient subsequently underwent next-generation sequencing (NGS) to guide chemotherapy.DISCUSSION: Adenocarcinoma is the most prevalent lung cancer accounting for >50% of all cases. Although frequently presents with pulmonary symptoms, lung cancer can also present, though rarely, with cardiac symptoms. NSCLC manifesting as malignant pericardial effusion/tamponade has a prevalence of about 6-7%. Large malignant pericardial effusions can present with various symptoms and signs, including elevated JVP, distant heart sounds, pulsus paradoxus, and hypotension from tamponade. An echocardiogram is the preferred diagnostic study, though EKG and CXR can help to aid in the diagnosis. Cytology from malignant pericardial effusions is shown to have a sensitivity between 66.7% - 92%. Initial treatment is aimed at ensuring reversal of tamponade and worsening hemodynamic compromise, symptomatic relief, and the prevention of recurrence. (1, 2)CONCLUSIONS: Unexplained pericardial effusion in patients with risk factors for lung cancer should prompt the workup for the diagnosis of underlying lung malignancy.Reference #1: 1. Dessalegn N, Felux K, Seid E, Mohammed A. Primary Lung Adenocarcinoma Presenting as Cardiac Tamponade in a 40-Year-Old Non-Smoker. Cureus. 2022;14(1):e21631. Published 2022 Jan 26. doi:10.7759/cureus.21631Reference #2: 2. Vemireddy LP, Jain N, Aqeel A, Jeelani HM, Shayuk M. Lung Adenocarcinoma Presenting as Malignant Pericardial Effusion/Tamponade. Cureus. 2021;13(3):e13762. Published 2021 Mar 8. doi:10.7759/cureus.13762DISCLOSURES: No relevant relationships by Haytham AdadaNo relevant relationships by Mahmoud AmarnaNo relevant relationships by Camelia ChirculescuNo relevant relationships by Ibrahim NakhoulNo relevant relationships by Dakota RobertsonNo relevant relationships by MRIDULA TALARINo relevant relationships by Mallika Velichety SESSION TITLE: Lung Cancer Case Report Posters 3 SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Lung cancer is the leading cause of cancer deaths in the U.S. and is broadly categorized as non-small cell lung cancer (NSCLC), comprising 80% of the cases, and small cell lung cancer (SCLC). Although common presentations include pulmonary symptoms of cough, dyspnea, and pleuritic chest pain, lung malignancies can present in a myriad of ways. Malignant pericardial effusion with tamponade physiology is an unusual initial presentation of primary lung cancer and it is associated with poor prognosis. (1) CASE PRESENTATION: A 72-year-old female with a history of depression, hyperlipidemia, hypertension, and tobacco abuse presented with a 6-week history of shortness of breath, dry cough, decreased appetite, and fatigue. With an initial diagnosis of pneumonia, she was prescribed multiple rounds of antibiotics without any improvement. On examination, she was tachycardic, tachypneic, and hypoxemic with oxygen saturation of 92% on 2 liters nasal cannula. Heart sounds were distant on auscultation, and elevated jugular venous pressure (JVP) was noted. Initial labs were unremarkable. CT angiogram of the chest demonstrated moderate pericardial effusion measuring approximately 2cm posteriorly. EKG revealed low voltage QRS with electrical alternans, and a subsequent echocardiogram revealed a large (>2cm) circumferential pericardial effusion with right ventricular diastolic collapse consistent with cardiac tamponade. The patient underwent emergent pericardiocentesis with 700cc of fluid removed. Cytology of pericardial fluid was consistent with adenocarcinoma showing malignant cells positive for MOC-31 and Ber-EP4. Furthermore, the majority of the malignant cells were TTF-1 positive, supporting adenocarcinoma of pulmonary origin. An echocardiogram before discharge showed resolution of tamponade physiology. The patient subsequently underwent next-generation sequencing (NGS) to guide chemotherapy. DISCUSSION: Adenocarcinoma is the most prevalent lung cancer accounting for >50% of all cases. Although frequently presents with pulmonary symptoms, lung cancer can also present, though rarely, with cardiac symptoms. NSCLC manifesting as malignant pericardial effusion/tamponade has a prevalence of about 6-7%. Large malignant pericardial effusions can present with various symptoms and signs, including elevated JVP, distant heart sounds, pulsus paradoxus, and hypotension from tamponade. An echocardiogram is the preferred diagnostic study, though EKG and CXR can help to aid in the diagnosis. Cytology from malignant pericardial effusions is shown to have a sensitivity between 66.7% - 92%. Initial treatment is aimed at ensuring reversal of tamponade and worsening hemodynamic compromise, symptomatic relief, and the prevention of recurrence. (1, 2) CONCLUSIONS: Unexplained pericardial effusion in patients with risk factors for lung cancer should prompt the workup for the diagnosis of underlying lung malignancy. Reference #1: 1. Dessalegn N, Felux K, Seid E, Mohammed A. Primary Lung Adenocarcinoma Presenting as Cardiac Tamponade in a 40-Year-Old Non-Smoker. Cureus. 2022;14(1):e21631. Published 2022 Jan 26. doi:10.7759/cureus.21631 Reference #2: 2. Vemireddy LP, Jain N, Aqeel A, Jeelani HM, Shayuk M. Lung Adenocarcinoma Presenting as Malignant Pericardial Effusion/Tamponade. Cureus. 2021;13(3):e13762. Published 2021 Mar 8. doi:10.7759/cureus.13762 DISCLOSURES: No relevant relationships by Haytham Adada No relevant relationships by Mahmoud Amarna No relevant relationships by Camelia Chirculescu No relevant relationships by Ibrahim Nakhoul No relevant relationships by Dakota Robertson No relevant relationships by MRIDULA TALARI No relevant relationships by Mallika Velichety