High-Grade Serous Ovarian Carcinoma Presenting as Cardiac Tamponade.

We present a case report of ovarian carcinoma with pericardial metastasis causing echocardiographic tamponade. A woman in her 70s with breast cancer gene 1 (BRCA1), B7-H4 positive, high-grade serous ovarian carcinoma with metastasis to the lungs presented with subacute dyspnea. Echocardiogram showed a large, circumferential pericardial effusion of 2.5 cm with tamponade physiology. Emergent pericardiocentesis yielded 420 mL of serosanguinous fluid. Cytology of the pericardial fluid was consistent with metastatic adenocarcinoma of ovarian origin. The patient pursued hospice care, where she later died. Ovarian carcinomas rarely metastasize above the diaphragm or to the heart. Few cases have been reported on cytology-positive high-grade serous ovarian carcinoma from pericardial fluid of a patient presenting with tamponade. A pericardial effusion is the most common manifestation of ovarian cancer metastatic to the heart.