Primary pericardial mesothelioma presenting as pericardial constriction: a case report

Abstract

A 19 year old man presented with a six month history of chest pain, dyspnoea, and lethargy and was found on an echocardiogram to have a dilated left ventricle with a small pericardial effusion. Ramipril and a course of steroids were tried but serial echocardiograms showed a persistently thickened pericardium and slowly developing features of constriction. On computed tomography, a large mediastinal mass encasing the heart, along with para-aortic and paratracheal lymphadenopathy, was found. Right heart catheter studies showed equal pressures in all four chambers. His deteriorating clinical condition led to a pericardiectomy. Histology confirmed primary pericardial mesothelioma. The patient died soon after surgery.

Figure 1

CT section through the aortic root showing large right pleural effusion and a low attenuation soft ring encasing the heart. The posterior displacement of the left atrium from the main coronary artery and LAD suggests this is due to soft tissue rather than fluid (arrows).

Figure 2

CT section more inferiorly showing slight difference in attenuation between pleural fluid (white arrows) and pericardial mesothelioma (black arrows). Cardiac silhoutte is enlarged, although the heart is small.

Figure 3

Histology: section of pericardium showing diffuse infiltration by epithelioid cells which had an immunohistochemical profile in keeping with malignant mesothelioma.