Malignant primary pericardial mesothelioma presenting as effusive constrictive pericarditis: a case report study

Our plain-English summary of Malignant primary pericardial mesothelioma presenting as effusive constrictive pericarditis: a case report study, by A. Savarrakhsh, A. Vakilpour, S.Z. Davani, et al (Journal of Cardiothoracic Surgery, 2021).

The study

• Authors: A. Savarrakhsh, A. Vakilpour, S.Z. Davani, M. Daskareh, M. Morsaghian, A. Salari, S.F. Mirrazeghi
• Journal: Journal of Cardiothoracic Surgery
• Published: 2021;16(1):298
• Type of article: Case report
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Primary 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 Presentation: This 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.

Conclusion: Constrictive 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.

© 2021. The Author(s).

In plain English

This case report described one patient: a 44-year-old woman who went to an emergency department in November 2020 with upper abdominal (epigastric) pain and worsening breathlessness. The article states she was a non-smoker with no history of asbestos exposure. Her lactate dehydrogenase (LDH) level was high, at 1757 U/L. A heart ultrasound showed a thickened pericardium (the sac around the heart), fluid and a mass-like lesion. The authors described these findings as consistent with constrictive pericarditis. A CT scan showed a chest mass, lymph nodes and liver lesions. She also tested positive for COVID-19 and recovered. During surgery to remove the pericardium, the surgeons saw the disease infiltrating the heart muscle. Tissue examination showed malignant epithelioid mesothelioma of the pericardium, 4 cm in greatest diameter. Mesothelioma was also found on the surface of the thymus gland. After four cycles of pemetrexed and carboplatin chemotherapy, she was reported to be without symptoms and in remission. The authors concluded that awareness of this rare, highly lethal cancer matters in various heart presentations, especially when there is no clear explanation or response to treatment.

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 patient)
• Who was studied: One 44-year-old woman who came to an emergency department in November 2020 with epigastric pain and progressive shortness of breath. The authors work at hospitals in Iran.
• Exposure: No asbestos exposure: the article states the patient was a non-smoker with no history of asbestos exposure.
• Main results:
  • The patient's lactate dehydrogenase (LDH) level was raised, at 1757 U/L.
  • Echocardiography showed a thickened pericardium, pericardial effusion and a mass-like lesion. The authors judged these findings consistent with constrictive pericarditis.
  • CT scan showed multiple lymph nodes in the mediastinum (central chest) and multiple hypoechoic lesions in the liver.
  • The patient tested positive for COVID-19 and recovered.
  • During pericardiectomy, the pericardium looked abnormal and infiltration into the heart muscle was visible.
  • Histopathology of the pericardial lesion showed malignant epithelioid mesothelioma, 4 cm in greatest diameter.
  • Malignant mesothelioma was present on the surface of the thymus gland. No clear-cut evidence of invasion into the thymus was detected.
  • After four cycles of pemetrexed and carboplatin chemotherapy, the patient had no complications and was reported to be without symptoms and in remission.
• The authors' conclusion: The authors concluded that effusive constrictive pericarditis is an unconventional presentation of primary pericardial mesothelioma. In their view, it is important to be aware of this condition across various cardiac presentations, particularly when there is no clear explanation or response to treatment.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Autopsy, Pericardium, Pericardial Effusion, Mediastinum, Pericardiectomy, Histopathology, Chemotherapy.

Related studies

• Asbestos induced pericardial effusion and constrictive pericarditis — D. Davies, M.I. Andrews, et al. (1991)
• A case of pleural mesothelioma with effusive-constrictive pericarditis — N.A. Weir, B. Gerstenhaber (2001)
• Constrictive pericarditis in a patient with fiberglass lung disease: a case report — C.Y. Hsu, H.Y. Chen, et al. (2024)
• Pericardiectomy for treatment of neoplastic constrictive pericarditis — F. Buyukbayrak, E. Aksoy, et al. (2014)
• Constrictive pericarditis after left extrapleural pneumonectomy and radiotherapy for malignant mesothelioma — E.J. Hickey, A.A. Khan, et al. (2007)
• Primary malignant pericardial mesothelioma presenting as constrictive pericarditis with an atypical imaging appearance: a case description — Y. Chen, X. Ren, et al. (2023)

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