Abstract
IntroductionPrimary malignant pericardial mesothelioma is a very rare pericardial tumor of unknown etiology.Case presentationA 61-year-old Caucasian woman was admitted to our hospital complaining of exertional dyspnea due to a large pericardial effusion. Intrapericardial fluid volume declined after repeated pericardiocentesis, but the patient progressively developed a hemodynamically relevant pericardial constriction. Pericardiectomy revealed a pericardial mesothelioma. Subsequently, four cycles of chemotherapy (dosage according to recently published trials) were administered. The patient remained asymptomatic, and there was no recurrence of the tumor after three years.ConclusionPericardial mesothelioma should be considered and managed appropriately in non-responders to pericardiocentesis, and in patients who develop constrictive pericarditis late in their clinical course.
Highlights
Primary malignant pericardial mesothelioma is a very rare pericardial tumor of unknown etiology
Case presentation: A 61-year-old Caucasian woman was admitted to our hospital complaining of exertional dyspnea due to a large pericardial effusion
Intrapericardial fluid volume declined after repeated pericardiocentesis, but the patient progressively developed a hemodynamically relevant pericardial constriction
Summary
Primary malignant pericardial mesothelioma is a very rare pericardial tumor of unknown etiology. The patient was re-admitted three months later, and transthoracic echocardiography showed a recurrent large pericardial effusion with partly organized fibrinous structures inside the effusion. Magnetic resonance imaging (MRI) confirmed the pericardial effusion, and the slightly thickened pericardium (Figure 2, Movies 3 and 4). A partial pericardiectomy was performed, and histological examination (Figures 4a and 4b) revealed a primary malignant pericardial mesothelioma (PMPM). This finding initiated additional subtotal pericardiectomy with resection of as much pericardium as possible. There was no indication of tumor spread to adjacent structures, and there was no tumor on the epicardial site This was considered to be a PMPM because no signs of a pleural mesothelioma were found. The patient remained asymptomatic, and there was no recurrence of the tumor during the three years
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