{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T10:40:17Z","timestamp":1756377617159,"version":"3.44.0"},"reference-count":15,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2024,10,24]]},"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:p>Metastatic breast cancer presenting with both cardiac tamponade and bilateral vocal cord paralysis is rare. We report a case of an elderly patient with breast cancer who had previously undergone right modified radical mastectomy and then presented with cardiac tamponade and recurrent laryngeal nerve paralysis as complications of the malignancy. She underwent right anterior thoracotomy, pleuropericardial window, left tube thoracostomy and tracheostomy under general anaesthesia. Anaesthetic goal was to secure a potentially difficult airway caused by reduced glottic dimensions secondary to bilateral vocal cord paralysis, while simultaneously maintaining preload, systemic vascular resistance and oxygenation, given the presence of cardiac tamponade. This case highlights a rare presentation of advanced breast cancer and emphasises the devastating implications of these conditions for patients, thus warranting further discussion on their anaesthetic management.<\/jats:p>","DOI":"10.1136\/bcr-2024-262557","type":"journal-article","created":{"date-parts":[[2024,11,13]],"date-time":"2024-11-13T21:50:19Z","timestamp":1731534619000},"page":"e262557","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Anaesthetic management of a breast cancer patient with cardiac tamponade and bilateral vocal cord paralysis"],"prefix":"10.1136","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-4517-7023","authenticated-orcid":false,"given":"Ariane Ilog","family":"Ramirez","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Philippine General Hospital, University of the Philippines Manila, Manila, Metro Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7313-0008","authenticated-orcid":false,"given":"Geraldine Raphaela Bernardo","family":"Jose","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Philippine General Hospital, University of the Philippines Manila, Manila, Metro Manila, Philippines"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,11,13]]},"reference":[{"key":"2025082803032484000_17.11.e262557.1","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2021-243700","article-title":"Receptor conversion and vocal cord paralysis in a patient with breast cancer","volume":"15","author":"Tan","year":"2022","journal-title":"BMJ Case Rep"},{"key":"2025082803032484000_17.11.e262557.2","article-title":"Cardiac Tamponade in Patients With Breast Cancer: A Systematic Review","volume":"14","author":"Ilerhunmwuwa","year":"2022","journal-title":"Cureus"},{"key":"2025082803032484000_17.11.e262557.3","doi-asserted-by":"crossref","DOI":"10.1155\/2012\/230736","article-title":"Cardiovocal Syndrome (Ortner\u2019s Syndrome) Associated with Chronic Thromboembolic Pulmonary Hypertension and Giant Pulmonary Artery Aneurysm: Case Report and Review of the Literature","volume":"2012","author":"Heikkinen","year":"2012","journal-title":"Case Rep Med"},{"key":"2025082803032484000_17.11.e262557.4","doi-asserted-by":"publisher","DOI":"10.1097\/00007611-197407000-00014"},{"key":"2025082803032484000_17.11.e262557.5","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1017\/S0022215100022301","article-title":"Paralysis of the Vocal Cords Secondary to Malignant Tumour of the Mamma","volume":"36","author":"Turner","year":"1921","journal-title":"J Laryngol Otol"},{"key":"2025082803032484000_17.11.e262557.6","unstructured":"Alternating increased unilateral vocal cord uptake in a patient with metastatic breast cancer. 2024. Available: https:\/\/www.oatext.com\/Alternating-increased-unilateral-vocal-cord-uptake-in-a-patient-with-metastatic-breast-cancer.php"},{"key":"2025082803032484000_17.11.e262557.7","unstructured":"Paralysis P . Vocal card paralysis. In: Updates on laryngology. IntechOpen, 2023. Available: https:\/\/www.intechopen.com\/books\/11086"},{"key":"2025082803032484000_17.11.e262557.8","unstructured":"Salik I , Winters R . Bilateral vocal cord paralysis. PubMed. Treasure Island (FL): StatPearls Publishing; 2021. Available: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK560852\/"},{"key":"2025082803032484000_17.11.e262557.9","article-title":"Malignant Cardiac Tamponade: A Complication of Untreated Breast Cancer","volume":"14","author":"Almajed","year":"2022","journal-title":"Cureus"},{"key":"2025082803032484000_17.11.e262557.10","first-page":"9573","article-title":"Survival outcome of cancer patients with pericardial effusions","volume":"33","author":"El Haddad","year":"2015","journal-title":"J C O"},{"key":"2025082803032484000_17.11.e262557.11","first-page":"443","article-title":"AANA Journal Course - Vocal Cord Paralysis: Implications for Anesthesia Care","volume":"89","author":"Maresch","year":"2021","journal-title":"AANA J"},{"key":"2025082803032484000_17.11.e262557.12","article-title":"Airway Anesthesia for Awake Tracheal Intubation: A Review of the Literature","volume":"13","author":"Kostyk","year":"2021","journal-title":"Cureus"},{"key":"2025082803032484000_17.11.e262557.13","doi-asserted-by":"publisher","DOI":"10.1213\/01.ane.0000249790.89467.af"},{"key":"2025082803032484000_17.11.e262557.14","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/j.bjae.2020.03.006","article-title":"Perioperative implications of pericardial effusions and cardiac tamponade","volume":"20","author":"Madhivathanan","year":"2020","journal-title":"BJA Educ"},{"key":"2025082803032484000_17.11.e262557.15","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1177\/0194599818756285","article-title":"Unilateral Vocal Fold Paralysis and Risk of Pneumonia: A Nationwide Population-Based Cohort Study","volume":"158","author":"Tsai","year":"2018","journal-title":"Otolaryngol Head Neck Surg"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-262557","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T10:03:34Z","timestamp":1756375414000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-262557"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11]]},"references-count":15,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11,13]]},"published-print":{"date-parts":[[2024,11]]}},"alternative-id":["10.1136\/bcr-2024-262557"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-262557","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2024,11]]}}}