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Weekly Chest CasesArchive of Old Cases

Case No : 222 Date 2002-01-26

  • Courtesy of NaMi Choi, M.D., Young Cheol Yoon, M.D., Kyung Soo Lee, M.D. / Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Korea
  • Age/Sex 34 / M
  • Chief ComplaintDyspnea and chest discomfort for 4 months
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Primary Pericardial Mesothelioma
Radiologic Findings
Initial chest radiography shows enlarged cardiac silhouette with bilateral pleural effusion. Enhanced chest CT scans demonstrate multiloculated pericardial effusion with pressure effect on SVC and left atrium. Note fluid-fluid level within the fluid collection posterior to LA, suggesting accompanying hemorrhage. The attenuation of the pericardial lesion within transverse pericardial sinus is relatively high, suggesting the presence of hemorrhage or solid tumor mass.
Diagnosis of pericardial epithelioid mesothelioma was made after pericardiectomy.
Brief Review
Pericardial mesothelioma arises from the mesothelial cells of the pericardium. Although pericardial mesothelioma represents less than 1% of all malignant mesotheliomas, it is the most common primary pericardial tumor, which accounts for 50% of all. Patient’s age ranges from 2 to 78 years, with mean age of 46 years and a 2:1 male-to-female ratio. Clinical symptoms include chest pain, cough, dyspnea, and palpitations. Patient with diffuse pericardial involvement may present with symptoms and sign that mimic pericarditis or cardiac tamponade. Patient with advanced tumors may present with widespread metastasis. Pericardial mesothelioma is usually unresectable and almost always incurable. Pericardial mesothelioma typically forms multiple coalescing pericardial masses that obliterate the pericardial space and constrict the heart. Cut sections of the masses are firm, white, and homogenous.
Chest radiography typically demonstrates cardiac enlargement, evidence of pericardial effusion, an irregular cardiac contour, or diffuse mediastinal enlargement. Chest CT demonstrates irregular, diffuse pericardial thickening and pericardial effusion. MR imaging also readily demonstrates cardiac encasement by a soft-tissue pericardial mass, as well as an associated pericardial effusion.
References
1. Mary L. Grebenc, Melissa L. Rosado de Christenson, Allen P. Burke, et al. Primary cardiac and pericardial neoplasm: Radiologic-pathologic correlation. Radiographics 2000;20:1073-1403
2. Warren WH. Malignancies involving the pericardium. Semin thorac Cardiovasc Surg 2000;12(2):119-129
Keywords
Pericardium, Malignant tumor,

No. of Applicants : 16

▶ Correct Answer : 7/16,  43.8%
  • - Ansung Public Health Center, Il-Jook branch, Korea Joon Woo Lee
  • - Choong-ju Hospital Konkuk University, Korea Chang Hee Lee
  • - Gochang Hospital, Korea Jiyong Rhee
  • - Harasanshin hospital, Fukuoka, Japan Shunya Sunami
  • - Korea Cancer Center Hospital, Korea Donghee Park
  • - Stedelijk OLV Ziekenhuis Mechelen, Belgium Ivan Pilate
  • - Sungji Hospital, Korea Jung Hee Kim
▶ Semi-Correct Answer : 4/16,  25.0%
  • - CHU Nancy-Brabois, France Denis Regent
  • - MH[CTC] Pune, India Vivek Sharma
  • - Ospedale di Jesi, Italy Giancarlo Passarini
  • - Wallaece Memorial Baptist Hospital,Korea Mi Ok Sun Woo
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Current Editor : Sung Shine Shim, MD, PhD. Email : sinisim@ewha.ac.kr

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