Fatal hemopericardial tamponade due to primary pericardial mesothelioma: a case report

Our plain-English summary of Fatal hemopericardial tamponade due to primary pericardial mesothelioma: a case report, by D.C. Lingamfelter, D. Cavuoti, A.C. Gruszecki (Diagnostic Pathology, 2009).

The study

• Authors: D.C. Lingamfelter, D. Cavuoti, A.C. Gruszecki
• Journal: Diagnostic Pathology
• Published: 2009;4:44
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Primary mesothelioma of the pericardium comprises less than 1% of all mesothelioma cases. Its typical presentation is insidious, with nonspecific signs and symptoms, and usually results in heart failure due to cardiac tamponade, either by a serous effusion or by direct tumorous constriction of the heart. With the exception of several case reports, the outcome is uniformly fatal, and patients typically die within six months of diagnosis.

Case Presentation: A 45-year-old African American female presented to the emergency department with several days of dizziness, difficulty walking, and low blood pressure. The patient suddenly suffered cardiac arrest, and her death was pronounced. The medical examiner assumed jurisdiction of the case due to the sudden death nature of the case without known medical history. At autopsy, a one-liter hemopericardium was present, and the pericardial sac was thick, granular and adhesed to the heart, suspicious for pericarditis. Microscopic examination of the pericardial tissue instead led to a diagnosis of primary pericardial mesothelioma.

Conclusion: Our case demonstrates a pericardial mesothelioma initially masquerading grossly as pericarditis. Microscopic examination of any grossly abnormal pericardial tissue therefore may be warranted so that a neoplastic disease process does not go undetected. Additionally, of the approximately 200 such tumors reported in the medical literature, a case demonstrating marked hemopericardium and resulting in sudden death has not been described until now.

In plain English

This article was a case report about one person: a 45-year-old African American woman who went to an emergency department with new dizziness, difficulty walking and low blood pressure. Her lab tests were normal and she was released. The next day her symptoms had worsened, she developed multiple organ failure and cardiac arrest, and she died. The article reported that she smoked tobacco and had no history of asbestos exposure. At autopsy, about one liter of blood was found in the sac around the heart (the pericardium). The pericardium was thickened, granular and stuck to the heart in places, and was at first taken to be pericarditis (inflammation). No suspicious cancer was seen elsewhere in the body. Microscopic examination and special stains led to a diagnosis of primary pericardial mesothelioma. Death was attributed to cardiac tamponade (compression of the heart) due to pericarditis due to mesothelioma of the pericardial sac. The authors stated that no earlier reported case had shown marked bleeding into the pericardium with sudden death. They concluded that, without microscopic examination of abnormal-looking pericardial tissue, a more serious disease such as a cancer could go undetected.

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 report (single autopsy case)
• Who was studied: One 45-year-old African American woman seen in an emergency department who died suddenly; autopsy under medical examiner jurisdiction (US authors, Missouri and Texas)
• Exposure: No history of asbestos exposure was reported; the patient smoked tobacco. No fiber type or dose is given.
• Main results:
  • At autopsy, approximately one liter of blood was in the pericardial cavity
  • The pericardial sac was focally stuck to the surface of the heart
  • The rest of the autopsy showed no grossly suspicious malignancy
  • Microscopy showed tumor cell clusters forming gland-like and papillary structures
  • Immunohistochemical stains were markedly positive for pancytokeratin, CK5/6 and calretinin, confirming primary pericardial mesothelioma
  • Cause of death was reported as cardiac tamponade due to pericarditis due to mesothelioma of the pericardial sac
  • The authors stated that no previously reported case described a pericardial mesothelioma causing marked hemopericardium and sudden death
• The authors' conclusion: The authors concluded that the case questions the accuracy of diagnosing pericarditis by gross inspection alone, and that without microscopic examination of grossly abnormal pericardial tissue a more significant disease process, including a neoplastic one, could go undetected.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Mesothelioma, Pericardium, Cardiac Tamponade, Jurisdiction, Autopsy, Pericardial.

Related studies

• Cardiac tamponade as the initial manifestation of primary pericardial mesothelioma — M. Stein, A. Neuman, et al. (1995)
• Primary malignant pericardial mesothelioma presenting with cardiac tamponade — S. Matsuyama, T. Imazuru, et al. (2020)
• Sarcomatoid Type Primary Pericardial Mesothelioma with a Long-term Survival after the Onset of Cardiac Tamponade — C. Saisho, H. Ishii, et al. (2016)
• Primary Malignant Pericardial Epithelioid Mesothelioma Presenting as Cardiac Tamponade: A Case Report With Multimodality Imaging and Radiologic-Pathologic Correlation — S. Dhakal, P. Savoia, et al. (2026)
• Primary pericardial mesothelioma and asbestos exposure: a rare fatal disease — D.M.M. Freitas, R.L. Ramos, et al. (2017)
• A peculiar presentation of tamponade: pericardial mesothelioma — S.D. Syed Ahmad, F. Kirk, et al. (2024)

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