Patients sometimes have dyspnea and orthopnea because the initial symptoms

 Pericardial effusion pericardial effusion develops in 5%
to 10% of lung cancer patients. at autopsy, cardiac involvement
occurs during approximately 15% of cases. sixty, 61 pericardial
effusion typically occurs within the setting of locally advanced
disease. patients sometimes have dyspnea and orthopnea because the
initial symptoms. the opposite symptoms and signs associated
with pericardial effusion are anxiety, substernal chest tightness,
jugular venous distension, and hepatomegaly.
pericardial effusion inflicting cardiac tamponade is missed
in up to 1 third of patients. the symptoms may be merely dyspnea
and anxiety and are usually attributed to progression of
parenchymal lung disease. the finding of dyspnea without
concurrent hypoxia during an anxious, dyspneic patient with locally
advanced lung cancer ought to prompt an investigation for
pericardial disease.
management of pericardial disease is dependent on whether
the patient has cardiac tamponade. patients with tamponade
require immediate intervention with the preferred treatment
being pericardiotomy (pericardial window) via a subxiphoid
approach. 62 patients with terribly short expected survival or patients
who don't have tamponade might be treated with pericardiocentesis.
if appropriate expertise could be available, placement of
alittle bore pericardial catheter may be effective. such a catheter
might be used to instill a sclerosing agent, that might help
achieve long-term management of the effusion in several patients. 63
pericardial effusion may be a late complication of chest radiation
therapy (with or while not chemotherapy) when significant
portions of the pericardium are included within the radiation
field. 64 so, occurrence of pericardial effusion during a patient
who has received chest radiation shouldn't be assumed
to be tumor recurrence.