Abstract
A 77-year-old man who had undergone mitral valve replacement 5 years previously presented with an intrapericardial mass. Computed tomography and magnetic resonance imaging showed that the mass lesion contained hematoma components. Positron-emission tomography (PET) with 2-[18 F] fluoro-2-deoxy-d-glucose (FDG) revealed uptake in the peripheral rim of the mass. These findings suggested the presence of hematoma associated with a malignant lesion. Surgical resection was performed, and the histological diagnosis was chronic expanding intrapericardial hematoma without neoplastic changes. Chronic expanding intrapericardial hematoma is a rare disease but should be considered when an expanding mass is found in a patient after cardiac surgery. The FDG-PET findings of chronic expanding hematomas, including FDG uptake in the peripheral rim of the mass as a result of inflammation, should be recognized as a potential interpretive pitfall that mimics a malignant tumor.
Highlights
Chronic expanding intrapericardial hematoma is a rare disease that occurs after open heart surgery, chest trauma, or epicardial injury
Positron-emission tomography (PET) with 2-[18 F] fluoro2-deoxy-D-glucose (FDG) is an evolving diagnostic modality used for tumor detection, staging, therapeutic monitoring, and follow-up of various malignant tumors
Macroscopic observations showed that the resected mass consisted of a dark red, partially organized hematoma containing a small amount of liquid with a fibrous membrane (Figure 4a)
Summary
Chronic expanding intrapericardial hematoma is a rare disease that occurs after open heart surgery, chest trauma, or epicardial injury. We found only a few reports on chronic expanding hematomas, and they had very limited FDG-PET imaging features [4,5,6]. A T2-weighted image (T2WI) demonstrated a mixture of high- and low-intensity areas (Figure 2b). A low-intensity septum and a peripheral rim were observed in the mass on both T1WI and T2WI. FDG-PET images revealed uptake in the peripheral rim of the mass (Figure 3a, 3b). Macroscopic observations showed that the resected mass consisted of a dark red, partially organized hematoma containing a small amount of liquid with a fibrous membrane (Figure 4a). No malignant change was observed (Figure 4b) This confirmed a diagnosis of chronic expanding intrapericardial hematoma. The area of focal infiltration of hemosiderin-laden macrophages was consistent with high FDG uptake in the peripheral area of the mass. 2 years after the operation, there is no sign of recurrence
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