Abstract
BackgroundPrimary pericardial mesothelioma (PPM) is a rare malignancy with a high prevalence of mortality. The diagnosis is usually challenging using a variety of imaging modalities and invasive procedures and is generally performed at the later stages of the disease or in autopsy. This case study points to an unconventional presentation of PPM and the challenges in diagnosing this rare mortal malignancy.Case presentationThis study presents a 44-year-old woman with no remarkable medical history with an initial diagnosis of effusive constrictive pericarditis at first hospitalization. Imaging evaluations, including transthoracic echocardiography and chest computed tomography scan, demonstrated visible thickened pericardium, pericardial effusion, and mass-like lesions in pericardium and mediastinum. The definite diagnosis of primary pericardial mesothelioma was established after pericardiectomy and histopathology examinations. Chemotherapy with pemetrexed and carboplatin was administrated to the patient, and she has been through four cycles of chemotherapy with no complications to date.ConclusionConstrictive pericarditis is an uncommon presentation of PPM. Due to the high mortality rate and late presentation, difficulties and uncertainties in diagnosis, being aware of this rare malignant entity in different cardiac manifestations, particularly when there is no clear explanation or response to treatment in such conditions, is highly important.
Highlights
ConclusionConstrictive pericarditis is an uncommon presentation of Primary pericardial mesothelioma (PPM). Due to the high mortality rate and late presentation, difficulties and uncertainties in diagnosis, being aware of this rare malignant entity in different cardiac manifestations, when there is no clear explanation or response to treatment in such conditions, is highly important
Primary pericardial mesothelioma (PPM) is a rare malignancy with a high prevalence of mortality
Constrictive pericarditis is an uncommon presentation of PPM
Summary
Our patient was presented with non-specific symptoms and electrocardiography changes accompanied by elevated LDH and inflammatory markers. Effusive constrictive pericarditis, which is considered an unconventional presentation of PPM, was diagnosed. PPM is known as a rare and highly lethal disease due to itlate presentation and uncertainties in diagnosis, it is of importance to be aware of this condition in various cardiac manifestations, including pericardial effusion, cardiac tamponade, patients presenting with clinical and imaging findings consistent with constrictive pericarditis, and even heart failure presentations, when there is no clear explanation and response to treatment in such conditions
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