Sudden death due to cardiac tamponade from malignant pericardial involvement by metastatic lung cancer

Excerpt

After being ill with an “upper respiratory infection” for approximately 2 weeks duration, a 45-year-old black female called 911 due to vomiting and diarrhea of 2 days duration and then new onset of shortness of breath. When paramedics arrived at her home she was conscious, but upon transferring her to the stretcher, she had more trouble breathing and became unresponsive. Emergency advanced cardiac life support measures were immediately initiated, and she was transported to a local Emergency Department (ED). Upon arrival at the hospital, her Glasgow Coma Scale was 3 and cardiac monitoring showed pulseless electrical activity. Emergent chest X-ray revealed a somewhat enlarged heart and a possible right-sided pleural effusion, but no evidence of masses or lymphadenopathy (Fig. 1). A head CT and an enzyme immunoassay screen for influenza were negative. Resuscitation efforts were continued for a time but without success. The patient died in the ED approximately 25 min after arrival, without a known explanation for death. As such, the case was referred to the coroner’s office for further investigation.

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