Anaplastic Lymphoma Kinase-Positive Primary Lung Adenocarcinoma Presenting With Pericardial Effusion and Tamponade in a COVID-19 Patient: A Case Report

Abstract

Primary lung cancer usually presents in older adults with a smoking history. However, there is an estimated incidence of 15-20% among men who have never smoked. The diagnosis of lung malignancy can often be incidental. Moreover, cardiac tamponade can be an initial presentation of malignancy, especially lung cancer, as these are the most common tumors that involve the pericardium. Here, we present a 54-year-old male with no known medical history presented with dyspnea on exertion. He was found to have a large pericardial effusion with tamponade physiology on a bedside echocardiogram. He was also found to have bilateral deep vein thrombosis and pulmonary embolism on admission. The patient underwent an emergent pericardiocentesis due to hemodynamic compromise, and pericardial fluid cytology suggested adenocarcinoma with lung primary. Subsequently, gene testing revealed anaplastic lymphoma kinase-positive adenocarcinoma of the lung. The patient was discharged home with close oncology follow-up. It is imperative to recognize malignant pericardial effusion as one of the causes of dyspnea. Emergent pericardiocentesis may be needed in case of hemodynamic compromise and tenuous clinical status.

Keywords: alk-positive lung adenocarcinoma; covid-19; deep venous thrombosis; pericardial effusion; pulmonary embolus.

Figure 1. EKG exhibiting atrial fibrillation with electrical alternans.

EKG: electrocardiogram

Figure 2. DVT in the left popliteal vein.

DVT: deep vein thrombus

Figure 3. Large circumferential pericardial effusion surrounding the heart, as seen in the parasternal long axis.

Figure 4. Filling defect in the left central pulmonary artery.

Figure 5. Pericardial fluid tumor fragment.

Figure 6. Pericardial tissue carcinoma with TTF-1 stain (left) and EPCAM stain (right).

TTF: thyroid transcription factor 1; EPCAM: epithelial cell adhesion molecule