Telemedicine-Guided Pericardiocentesis for Cardiac Tamponade in Primary Mediastinal Large B-cell Lymphoma.
5 affiliations
- 1Internal Medicine, Hospital Universitario Dr. José Eleuterio González, Monterrey, MEX.
- 2Nephrology, Hospital Universitario Dr. José Eleuterio González, Monterrey, MEX.
- 3Cardiology, Hospital Universitario Dr. José Eleuterio González, Monterrey, MEX.
- 4Microbiology, Universidad Autónoma de Nuevo León, Monterrey, MEX.
- 5Pulmonary and Critical Care Medicine, Hospital Universitario Dr. José Eleuterio González, Monterrey, MEX.
Abstract
Pericardial effusion has infectious, inflammatory, neoplastic, traumatic, cardiac, vascular, and idiopathic causes. When effusion accumulates rapidly enough to compromise ventricular filling, cardiac tamponade develops and becomes a life-threatening emergency requiring urgent drainage, a procedure conventionally performed by a cardiologist or cardiothoracic surgeon and rarely available on site at rural or resource-limited hospitals. Malignant pericardial effusion is most often attributed to lung and breast carcinoma, while lymphoma is the leading hematologic cause. Tamponade as the presenting feature of non-Hodgkin lymphoma, however, is distinctly uncommon. We describe a 40-year-old man from a rural community in Nuevo León, Mexico, with three weeks of intermittent chest tightness, diaphoresis, unquantified fever, and approximately 7 kg of unintentional weight loss, followed by progressive exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. He presented to a rural hospital with jugular venous distension, muffled heart sounds, and lower-limb edema, without pulsus paradoxus. Echocardiography demonstrated a severe pericardial effusion measuring up to 4.6 cm with tamponade physiology. With no cardiologist on site and hemodynamic collapse imminent, an internist performed pericardiocentesis under real-time telemedicine guidance from a cardiologist, draining serosanguineous fluid whose biochemical profile suggested tumor involvement. Contrast-enhanced chest computed tomography at the referral center revealed a 14.4 × 11.8 × 11.3 cm anterior mediastinal mass with necrotic areas. Video-assisted thoracoscopic surgery allowed pericardial window creation and tumor biopsy, which established a CD20-positive primary mediastinal large B-cell lymphoma (PMBCL). Chemotherapy with R-CHOEP (rituximab, cyclophosphamide, doxorubicin, vincristine, etoposide, and prednisone) was initiated, with resolution of hemodynamic instability and no recurrence of tamponade during the reported follow-up. This case illustrates that malignancy warrants early consideration in unexplained tamponade and that real-time telemedicine guidance may allow a non-specialist physician to undertake a life-saving bedside procedure where specialist care is otherwise unavailable, an approach that merits further evaluation in rural and underserved settings.
Related
- First Presentation With Impending Cardiac Tamponade Leading to a New Diagnosis of Mediastinal Lymphoma: A Shared Learning Case on the Atypical Presentation of Pericardial Effusion and Cardiac Tamponade.
- Purulent cardiac tamponade associated with necrotic mediastinal lymphadenopathy: Multimodality imaging of a presumed mediastinal–pericardial pathway
- Recurrent Cardiac Tamponade Following an Open Mitral Valve Replacement
- Unexplained intraoperative cardiac tamponade during thoracoscopic lobectomy: a case report
- Recurrent Pericarditis With Cardiac Tamponade in a Patient With Systemic Lupus Erythematosus: A Case Report
BibTeX
@article{morales2026telemedicineguided,
title = {{Telemedicine-Guided Pericardiocentesis for Cardiac Tamponade in Primary Mediastinal Large B-cell Lymphoma.}},
author = {Victor A Cab Morales and Edgar A Montemayor Garza and César A Mascorro-Cienfuegos and Jorge L Aguilar-Meza and Nury A de la Cruz de León and Uriel Chavarría Martínez},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.116854},
url = {https://europepmc.org/article/MED/42927131},
note = {CC BY},
}
RIS
TY - JOUR
TI - Telemedicine-Guided Pericardiocentesis for Cardiac Tamponade in Primary Mediastinal Large B-cell Lymphoma.
AU - Victor A Cab Morales
AU - Edgar A Montemayor Garza
AU - César A Mascorro-Cienfuegos
AU - Jorge L Aguilar-Meza
AU - Nury A de la Cruz de León
AU - Uriel Chavarría Martínez
PY - 2026
DA - 2026/09/24
JO - Cureus
DO - 10.7759/cureus.116854
UR - https://europepmc.org/article/MED/42927131
AB - Pericardial effusion has infectious, inflammatory, neoplastic, traumatic, cardiac, vascular, and idiopathic causes. When effusion accumulates rapidly enough to compromise ventricular filling, cardiac tamponade develops and becomes a life-threatening emergency requiring urgent drainage, a procedure conventionally performed by a cardiologist or cardiothoracic surgeon and rarely available on site at rural or resource-limited hospitals. Malignant pericardial effusion is most often attributed to lung and breast carcinoma, while lymphoma is the leading hematologic cause. Tamponade as the presenting feature of non-Hodgkin lymphoma, however, is distinctly uncommon. We describe a 40-year-old man from a rural community in Nuevo León, Mexico, with three weeks of intermittent chest tightness, diaphoresis, unquantified fever, and approximately 7 kg of unintentional weight loss, followed by progressive exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. He presented to a rural hospital with jugular venous distension, muffled heart sounds, and lower-limb edema, without pulsus paradoxus. Echocardiography demonstrated a severe pericardial effusion measuring up to 4.6 cm with tamponade physiology. With no cardiologist on site and hemodynamic collapse imminent, an internist performed pericardiocentesis under real-time telemedicine guidance from a cardiologist, draining serosanguineous fluid whose biochemical profile suggested tumor involvement. Contrast-enhanced chest computed tomography at the referral center revealed a 14.4 × 11.8 × 11.3 cm anterior mediastinal mass with necrotic areas. Video-assisted thoracoscopic surgery allowed pericardial window creation and tumor biopsy, which established a CD20-positive primary mediastinal large B-cell lymphoma (PMBCL). Chemotherapy with R-CHOEP (rituximab, cyclophosphamide, doxorubicin, vincristine, etoposide, and prednisone) was initiated, with resolution of hemodynamic instability and no recurrence of tamponade during the reported follow-up. This case illustrates that malignancy warrants early consideration in unexplained tamponade and that real-time telemedicine guidance may allow a non-specialist physician to undertake a life-saving bedside procedure where specialist care is otherwise unavailable, an approach that merits further evaluation in rural and underserved settings.
SN - 2168-8184
ER -