A Shocking Diagnosis: Tamponade Unmasking Ovarian Cancer

Introduction: Ovarian cancer, the second most common gynecologic malignancy, typically presents with nonspecific abdominal symptoms such as bloating, distension, and abdominal pain. This can often lead to a delayed diagnosis. Ovarian cancer with cardiac involvement is exceedingly rare. Here, we present a case of a woman with no prior oncologic history who presented with obstructive shock secondary to cardiac tamponade. Diagnostic evaluation revealed high-grade serous ovarian carcinoma, highlighting an uncommon but critical manifestation of gynecologic malignancy.


Description: An 80-year-old female presented to the hospital with the acute onset of presyncope, dyspnea, and chest pain. Initially, she was in acute respiratory failure and shock, requiring vasopressor support. Her workup included a CT of the chest, abdomen, and pelvis, which revealed a large pericardial effusion, liver lesions, and a unilateral adnexal mass. An echocardiogram confirmed the pericardial effusion with accompanying tamponade physiology. Emergent pericardiocentesis was performed, resulting in symptomatic relief and hemodynamic stabilization. Fluid cytology demonstrated malignant cells consistent with high-grade serous carcinoma of gynecologic origin, and she was diagnosed with metastatic ovarian cancer. After further discussion, the patient elected to be discharged home with hospice care.


Discussion: Ovarian cancer is the leading cause of death among gynecologic malignancies, with approximately 75% of patients having metastatic disease at the time of diagnosis. Although gynecologic cancers rarely metastasize to the heart, such involvement can be life-threatening. Cardiac tamponade occurs when a pericardial effusion impairs ventricular filling, leading to hemodynamic instability. Cardiac tamponade can be caused by several pathologies, such as trauma and cardiothoracic surgery, but when caused by malignancy it carries a 49% mortality rate. The most common malignancies associated with pericardial effusions are lung, breast, and cancers of the gastrointestinal tract. Pericardiocentesis is the mainstay of treatment, but pericardial window and pericardial drains can be used for recurrent effusions. Prompt recognition and emergent intervention are critical not only for reversing hemodynamic compromise but for establishing a diagnosis.