Q. My daughter has tumors in the heart. What are the chances of survival?

Answered by
Dr. Sagar Ramesh Makode
and medically reviewed by iCliniq medical review team.
Published on Sep 25, 2017

Hello doctor,

My daughter is in the ICU with pericardial effusion and multiple tumors. The fluid has been drained and there was blood mixed with the fluid. The regular blood test came back normal with no sign of cancerous cells. My question is, what are the chances that the tumors are benign? Through my research, there is a good chance that the tumors could be a rhabdomyoma. My daughter is only 9 years old and I want to take her to the best facility. They said her heart is weak and are unable to perform any test on the tumors. They have her on Coretec and albumin and said that it was not working and put her on something stronger. Could this be a result of the pericardial effusion? I am attaching the blood test reports. They said everything was normal with no sign of cancerous cells, but are still unable to say for certain if it is benign or malignant.  I am just a very worried father.

Dr. Sagar Ramesh Makode

Cardiology General Medicine Internal Medicine
#

Hello,

Welcome to icliniq.com.

Firstly, there is a diagnostic dilemma. The reports you have uploaded (attachment removed to protect patient identity) are fine. But, you should upload the echo reports and the fluid investigations as well.

Now, considering the pericardial effusion with multiple cardiac tumors, the possibilities of a rhabdomyoma or a teratoma are high. However, an effusion is not common with rhabdomyoma. It is possible to have some other cause for the effusion and it can also be as a result of a heart failure. Both of these are benign tumors. However, at this stage, we cannot rule out a malignancy.

The next thing to be done is that she should undergo a cardiac MRI for further characterization of the lesions, which will give us a diagnosis and also resolve the issue of malignancy. Also, if the fluid is available, it should be tested for ADA (adenosine deaminase) and GeneXpert. She should also undergo a thyroid test.

Rhabdomyomas usually occurs in patients with tuberous sclerosis, so she should be adequately examined by the doctor for the same.

A definitive treatment is the excision of these tumors surgically. So, you can discuss this with the doctor as well.

Hope this helps you. Do write back in case of doubts.

Revert with more information to a cardiologist online --> https://icliniq.com./ask-a-doctor-online/cardiologist

Thank you doctor,

I do not have a copy of the echo, but they said that they tested the fluid and there was no sign of malignancy. However, they believe that the tumor is malignant. But, since the tumors are in the pericardial cavity and the pericardial fluid showed no sign of malignancy, what are the chances of the tumors being malignant? And if it is malignant what are the chances of survival? I have attached images of her blood pressure reading.

Dr. Sagar Ramesh Makode

Cardiology General Medicine Internal Medicine
#

Hello,

Welcome back to icliniq.com.

I have gone through the reports (attachment removed to protect patient identity).

  • Her BP is low and her pulse rate is high probably because the pericardial effusion is compressing the heart leading to a tamponade. A pigtail insertion should be done in the pericardial cavity and the fluid should be drained, if not being done already. An aspiration of the fluid should be done every day if the pigtail is already in situ.
  • Usually, not always, a pericardial effusion is caused by malignant tumors. But, the chances of a malignancy depends upon the picture of the tumor on an echo or other imaging like MRI or CT scan. We need multiple samples of fluid to detect the cells, as one or two can sometimes be negative. So you should request them to send the fluid every day till we have a diagnosis.
  • Sorry to mention that the prognosis, in the case of a malignant tumor, is not very good and the survival rate is poor. But, it will also depend on the exact type of tumor and the spread of the tumor to other structures. Also, the treatment plans like surgery, chemotherapy or radiotherapy will be decided after knowing the type of tumor. So, it is important to send repeated samples for testing. Also, the other option is pericardiotomy and biopsy of the masses. 

So, I think making a diagnosis is an important step here. Hope this helps you. All the best.

For further queries consult a cardiologist online --> https://icliniq.com./ask-a-doctor-online/cardiologist

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