Constrictive Pericarditis Caused by Primary Pericardial Mesothelioma: A Case Series

Our plain-English summary of Constrictive Pericarditis Caused by Primary Pericardial Mesothelioma: A Case Series, by T.A. Meijs, J.F. Heidendael, B. Schurink, et al (Circulation. Cardiovascular Imaging, 2024).

The study

• Authors: T.A. Meijs, J.F. Heidendael, B. Schurink, M. Bugiani, W.J.P. van Boven, S.M. Boekholdt, L.F.H.J. Robbers
• Journal: Circulation. Cardiovascular Imaging
• Published: 2024;17(11):e016847
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

In plain English

This case series from Amsterdam University Medical Center, the Netherlands, described two consecutive patients with primary pericardial mesothelioma, a cancer of the heart's lining. Both first had a large fluid buildup around the heart that was treated as pericarditis. Signs of constrictive pericarditis, a stiffened lining that restricts heart filling, appeared later. The first patient, a 38-year-old woman, had epithelioid-type mesothelioma. Scans showed no abnormal uptake outside the pericardium, including the pleurae. She had surgery to remove the pericardium and immune checkpoint inhibitor treatment. Six months after diagnosis she worsened. She eventually died of right-sided heart failure and widespread blood clots considered secondary to the cancer. The second patient, a 75-year-old man, had fluid tests showing no cancer cells. Tissue removed at surgery led to a diagnosis of malignant mesothelioma. He died 5 days later. Autopsy supported the mixed epithelioid and sarcomatoid type and found no tumor on the pleura. The article does not report whether either patient was exposed to asbestos. Citing an earlier review, the authors wrote that no evident link between asbestos and this disease has yet been identified. The authors concluded that this cancer should be considered in constrictive pericarditis without another clear cause.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case series (2 patients)
• Who was studied: Two consecutive patients at Amsterdam University Medical Center, the Netherlands: a 38-year-old woman (case 1) and a 75-year-old man (case 2), neither with significant prior clinical history; dates not given
• Exposure: The article does not report asbestos exposure or occupational history for either patient
• Main results:
  • Both patients first had pericardial effusion treated as pericarditis. Signs of constrictive physiology were found later (case 2: on repeat echocardiography).
  • Case 1 (38-year-old woman): pericardial tissue showed malignant mesothelioma of the epithelioid type
  • Case 1: PET/CT showed no abnormal uptake outside the pericardium, particularly not in the pleurae
  • Case 1: 6 months after diagnosis the patient developed progressive constrictive pericarditis. She eventually died of severe right-sided congestive heart failure and diffuse thromboembolisms considered to be secondary to the malignancy.
  • Pericardial uptake on PET/CT had a maximum standardized uptake value of 6.28 in case 1 and 8.74 in case 2
  • Case 2 (75-year-old man): pericardial and pleural fluid analysis did not show malignant cells
  • Case 2: histological examination after subtotal pericardiectomy led to a diagnosis of malignant mesothelioma
  • Case 2: pericardiectomy did not improve circulation, and the patient died of persistent cardiogenic shock 5 days later
  • Case 2: autopsy supported primary pericardial mesothelioma of the mixed epithelioid and sarcomatoid type, with no tumor on the visceral or parietal pleura
• The authors' conclusion: The authors concluded that primary pericardial mesothelioma is rare but highly aggressive. They said it should be considered in patients with constrictive pericarditis without another clear cause, and that combined CMR, CT and PET/CT imaging is useful in diagnosis.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma.

Related studies

• Primary malignant pericardial mesothelioma - a rare cause of pericardial effusion and consecutive constrictive pericarditis: a case report — T. Butz, L. Faber, et al. (2009)
• Malignant primary pericardial mesothelioma presenting as effusive constrictive pericarditis: a case report study — A. Savarrakhsh, A. Vakilpour, et al. (2021)
• Primary malignant pericardial mesothelioma presenting as constrictive pericarditis with an atypical imaging appearance: a case description — Y. Chen, X. Ren, et al. (2023)
• A Rare Cause of Constrictive Pericarditis: Primary Pericardial Mesothelioma — K. Ravindra, C. Vanchiere, et al. (2025)
• Primary Pericardial Mesothelioma Causing Constrictive Pericarditis — S.T. Luebbe, Q. Youmans, et al. (2025)
• Primary Malignant Pericardial Mesothelioma Manifesting as Constrictive Pericarditis with Atypical Imaging Features: A Case Report — E. Shahverdi, G. Santhosh Kumar, et al. (2026)

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