A Case of Transverse Colon Cancer Discovered due to Cardiac Tamponade

Abstract

A 64-year-old woman presented at a local clinic complaining of general malaise. Blood tests showed hepatic impairment, and she was referred to our hospital for further examination and treatment. Abdominal ultrasound conducted at an outpatient appointment to investigate the cause showed signs of hepatic congestion, and when echocardiography was performed, a large amount of circumferential pericardial effusion and reduced left ventricular ejection fraction were evident. Cardiac tamponade and right heart failure were diagnosed, and she was admitted as an emergency. Cytological examination of pericardial fluid collected by pericardiocentesis conducted during admission showed atypical cells, and carcinomatous cardiac tamponade was diagnosed. Thoracoabdominal contrast-enhanced computed tomography (CT) showed thickening of the wall of the transverse colon, enlargement of the para-aortic and mediastinal lymph nodes, and enlargement of the left adrenal gland. Thoracoabdominal magnetic resonance imaging (MRI) identified bone metastases in thoracic vertebra Th7 and lumbar vertebra L5. Lower gastrointestinal endoscopy showed circumferential Type 2 advanced cancer of the transverse colon, and cStage IV b transverse colon cancer was diagnosed based on these findings. This is an extremely rare case of the discovery of transverse colon cancer as a result of cardiac tamponade.