Primary pericardial mesothelioma presenting as multiple pericardial masses on CT

Abstract

We present the case of a 67-year-old male who was found to have multiple enhancing pericardial masses on CT imaging for investigation of weight loss and was subsequently diagnosed with primary pericardial mesothelioma. Although rare, pericardial mesothelioma is the most common primary malignancy of the pericardium and should be considered in the differential diagnosis of pericardial effusion, pericardial thickening or discreet pericardial mass. It is important for radiologists to be aware of pericardial mesothelioma as its clinical presentation is non-specific and it may be incidentally noted on radiological studies for investigation of apparently non-related symptoms. The prognosis of primary pericardial mesothelioma is universally poor.

Figure 1.

Contrast-enhanced CT scan of chest demonstrating multiple rim-enhancing, necrotic pericardial masses throughout the pericardium. (a) At the level of the left atrium; (b) mass effect on the pericardial structures with narrowing of the main pulmonary arteries; (c) coronal reconstruction demonstrating pericardial masses extending from the aortic arch superiorly to the diaphragm inferiorly.

Figure 2.

Image demonstrating core biopsy of one of the pericardial masses adjacent to the heart.

Figure 3.

(a) Low power view showing spindle cell proliferation of generally low but varying cellularity and associated stromal desmoplasia (haematoxylin and eosin ×100). (b) High power image highlighting areas of loosely clustered, mildly atypical mesothelial cells in a fibrotic background (haematoxylin and eosin ×400).