Intrapericardial bleomycin sclerotherapy achieved complete resolution of recurrent malignant pericardial effusion in a palliative lung cancer patient, with no recurrence on subsequent follow-up and substantial symptomatic improvement.
Key Findings
Results
Emergency pericardiocentesis provided only temporary palliation for malignant pericardial effusion, with recurrence occurring within 2 months.
Patient was a 50-year-old male chronic smoker with advanced lung cancer and pericardial metastasis
Initial emergency pericardiocentesis was performed but effusion recurred within 2 months
Recurrent effusion demonstrated hemodynamically significant tamponade physiology on echocardiography
Cytological analysis of pericardial fluid confirmed metastatic carcinoma consistent with lung cancer origin
Results
Second emergency pericardiocentesis drained approximately 1000 ml of hemorrhagic pericardial fluid.
Pericardiocentesis was performed following confirmation of recurrent cardiac tamponade
Fluid drained was described as hemorrhagic in character
Repeat imaging following drainage confirmed minimal residual effusion before proceeding to sclerotherapy
A pigtail catheter was used for the drainage procedure
Results
Intrapericardial instillation of 10 mg bleomycin via pigtail catheter achieved complete resolution of pericardial effusion.
Bleomycin dose was 10 mg diluted in normal saline
Administration was via intrapericardial instillation through a pigtail catheter
The catheter was clamped for 48 hours following instillation
Follow-up echocardiography confirmed complete resolution of pericardial effusion
No adverse effects were reported; the procedure was described as 'well tolerated'
Results
The patient experienced substantial symptomatic improvement in breathlessness, chest pain, and overall comfort following bleomycin pericardiodesis.
Symptomatic improvement was noted in breathlessness, chest pain, and overall comfort
No evidence of recurrence was found on subsequent follow-up
The intervention avoided the burden of repeated pericardiocentesis procedures
The approach was characterized as relevant particularly in resource-limited settings
Methods
Chemical pericardiodesis with bleomycin was performed as a minimally invasive palliative intervention to prevent reaccumulation of malignant pericardial effusion.
The procedure followed confirmation of minimal residual effusion on repeat imaging after pericardiocentesis
Bleomycin sclerotherapy was chosen as a minimally invasive alternative to surgical approaches
The authors describe this approach as relevant in palliative care settings to enhance quality of life
The case was reported from Bangladesh, emphasizing applicability in resource-limited settings
What This Means
This research describes a case report from Bangladesh of a 50-year-old man with advanced lung cancer who developed a dangerous buildup of fluid around his heart (malignant pericardial effusion) that kept coming back. When the heart is surrounded by too much fluid, it can compress the heart and become life-threatening — a condition called cardiac tamponade. The first emergency drainage procedure provided only temporary relief, and within two months the fluid had returned in dangerous quantities. A second emergency drainage removed about 1000 ml (roughly a liter) of bloody fluid.
After the second drainage, doctors injected a small dose (10 mg) of a drug called bleomycin directly into the space around the heart through the same drainage tube, then kept the tube clamped for 48 hours. Bleomycin acts as a sclerosing agent — it causes the inner lining of the pericardial sac to stick together, reducing the space where fluid can accumulate. The patient tolerated the procedure without side effects, and follow-up heart scans confirmed the fluid was completely gone. The patient's breathing difficulties and chest pain improved substantially, and no recurrence was detected on follow-up visits.
This research suggests that injecting bleomycin into the pericardial space is a safe and effective way to prevent dangerous fluid from returning in patients with advanced cancer who are receiving palliative (comfort-focused) care. The authors highlight that this minimally invasive approach may be especially valuable in resource-limited healthcare settings, where more complex surgical options may not be readily available, as it can spare patients from repeated emergency drainage procedures and improve their quality of life. However, as a single case report, broader conclusions would require larger studies.
Das S, Bhuiyan A, Alam A, Singha C, Chowdhury M. (2026). Managing malignant recurrent pericardial effusion in a palliative patient with bleomycin sclerotherapy: A case report from Bangladesh.. Medicine. https://doi.org/10.1097/MD.0000000000050509