Neoplastic Myocarditis as a Manifestation of Bronchogenic Carcinom

Abstract

Background: Myopericarditis, an inflammatory syndrome involving both the myocardium and pericardium, is typically idiopathic or viral in origin. Neoplastic causes are rare but should be considered in the presence of atypical features or systemic signs. Case Summary: We report the case of a 50-year-old male, chronic smoker, admitted to the intensive cardiac care unit for hemodynamically significant pericardial effusion. Initial work-up revealed an inflammatory syndrome, myocardial injury with elevated troponin, and large circumferential pericardial effusion. Pericardial drainage yielded hemorrhagic exudate, with cytological analysis identifying malignant adenocarcinoma cells. Imaging studies showed suspicious pulmonary and hepatic lesions, and cardiac MRI confirmed myocarditis. Coronary angiography ruled out ischemia. The patient was diagnosed with myopericarditis secondary to lung adenocarcinoma and referred for oncological management. Discussion: This case illustrates a rare presentation of lung cancer manifesting initially as myopericarditis with pericardial tamponade. Cardiac involvement in malignancy may result from direct invasion, lymphatic spread, or paraneoplastic mechanisms. Cardiac MRI and cytological analysis of pericardial fluid were pivotal in the diagnostic process. Early recognition of neoplastic myopericarditis is essential for prompt oncological referral and tailored management. Conclusion: Clinicians should consider malignancy in the differential diagnosis of myopericarditis, particularly in the presence of hemorrhagic effusion or systemic signs. Cardiac MRI and pericardial fluid analysis remain essential diagnostic tools in such contexts.