Symptoms of progressive exudative pericarditis and heart failure also indicate a possible spread of lung cancer in the heart.
The most informative method of radiological diagnosis of exudative tumor pericarditis is CT. However, due to the greater availability and cost-effectiveness in practical work, only radiological and ultrasound examinations are used for these purposes, as a rule. This data is usually quite sufficient for confident diagnosis of pericardial effusion. CT can be used in the second stage in diagnostically difficult cases to solve some special issues.
X-ray examination, in our opinion, may be limited to radiography, supplemented by x-ray or tomography to assess the pulsation of the cardiovascular shadow. The first signs of exudative pericarditis appear when more than 200ml effusion accumulates in the heart shirt in adults. The most characteristic symptoms are: an increase in the size of the heart shadow with a predominance of the diameter over
dlinnik, spherical shape of cardiac shadow, disappearance of arcs along its contours, shortening of the vascular bundle with a high position of cardio-vazal angles, expansion of the superior vena cava, weakening or even complete absence of pulsation along the contour of the cardiac shadow while maintaining aortic pulsation.
The ultrasound method allows you to detect fluid in the heart shirt starting at 50 ml. A direct and therefore main feature is the presence of an echo-negative space between the sheets of the pericardium. Additional indirect symptoms are the increased amplitude of the excursion of the heart walls, surrounded by fluid, and a sharp decrease in the amplitude of movement of the outer leaflet of the pericardium up to its complete immobility.
Computed tomography, along with reliable detection of the minimum amount of fluid in the pericardial cavity, compared with echocardiography has some advantages. They consist in the possibility of a more accurate estimate of the volume of the pericardial fluid and a tentative determination of its nature. The magnitude of the densitometric density of the liquid is +5 … +10 HU more typical of transudate, +10 … +20 HU — exudate, +20 … +40 HU — blood. The role of CT in recognition of encored pericarditis, in differentiating fluid with fibrous and tumor thickenings of the pericardium is especially great.
Heart failure with a secondary tumor of the heart may be left ventricular, right ventricular, but more often total. Radiographically, it is manifested by dilatation of an increase in the size of the heart and a decrease in the contractile function of the myocardium. The latter is established by fluoroscopy or kimographically to reduce the amplitude and deformation of the teeth. The logical consequence of heart failure is the difficulty of moving blood from one circulation to another. Left ventricular failure is characterized by impaired pulmonary circulation with the development of venous hypertension. Its radiological symptoms, corresponding to certain levels of pressure in the postcapillary link of the pulmonary circulation, are the redistribution of most of the pulmonary blood flow from the lower lung to the upper (cranialization), the development of interstitial and alveolar edema of the lungs. In right ventricular insufficiency, the right chambers of the heart are enlarged and the superior vena cava is expanded.Total heart failure leads to stagnation in both the lesser and greater circulatory circuits.
Much more accurately the functional state of the heart can be assessed by ultrasound, and quantitatively, with the calculation of such important indicators of global systolic function as stroke and minute volumes, ejection fraction.
Metastatic lesion of the heart should be assumed in every patient with lung cancer with a sudden appearance and rapid increase of any cardiac symptoms.