Pericardial mesothelioma: an incidental intraoperative diagnosis

Our plain-English summary of Pericardial mesothelioma: an incidental intraoperative diagnosis, by M. Griffin, W. Farmer, S. Garwood, et al (Journal of Cardiothoracic and Vascular Anesthesia, 1999).

The study

• Authors: M. Griffin, W. Farmer, S. Garwood, D. Lee
• Journal: Journal of Cardiothoracic and Vascular Anesthesia
• Published: 1999;13(4):471-4
• Type of article: Case report
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

Anesthesiologists at Yale University School of Medicine, New Haven, Connecticut, described an 83-year-old man in whom a pericardial mesothelioma was found incidentally during coronary artery bypass graft (CABG) surgery. They outlined how transesophageal echocardiography (TEE) contributed to the diagnosis and to intraoperative management. The man had 3 days of worsening chest pain and was diagnosed with non-Q wave myocardial infarction. Angiography showed severe multivessel coronary disease, and preoperative transthoracic echocardiography raised no suspicion of a mass. After induction of anesthesia, a pulmonary artery catheter could not be advanced beyond 20 cm, and TEE showed a mass almost occluding the right atrial cavity. TEE could not show whether the mass was inside or outside the heart. On opening the pericardium, the surgeons found a pancake-like slab of tissue over the ascending aorta, right atrium and right ventricle. It was completely resected, and TEE confirmed a normal right atrium. Pathology confirmed pericardial mesothelioma. The grafting was completed. Recovery was complicated by a catheter-related methicillin-resistant Staphylococcus aureus bloodstream infection, and he was discharged on postoperative day 35. The authors reviewed the echocardiographic differential diagnosis of right atrial masses and the features of pericardial mesothelioma, which they stated has not been linked to asbestos exposure. They concluded that TEE can contribute to diagnosis and intraoperative management in addition to its monitoring role.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This was a case report of an 83-year-old man who came for coronary artery bypass graft surgery after a heart attack. After anesthesia began, a pulmonary artery catheter could not be passed beyond 20 cm. Transesophageal echocardiography (an ultrasound probe in the esophagus) showed a mass almost blocking the right atrium of the heart. The scan could not show whether the mass was inside or outside the heart. When the pericardium (the sac around the heart) was opened and peeled off, the surgeons found a pancake-like slab of tissue over the ascending aorta, right atrium and right ventricle, and removed it completely. Pathology confirmed a pericardial mesothelioma. The man later had a bloodstream infection and went home 35 days after surgery. The article gave no asbestos exposure history for him. Citing earlier work, the authors wrote that primary malignant mesothelioma of the heart, unlike pleural mesothelioma, has not been linked to asbestos exposure. The authors concluded that the case showed how this ultrasound can aid diagnosis and management during surgery.

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 (one patient)
• Who was studied: One 83-year-old man having coronary artery bypass graft surgery after a non-Q wave myocardial infarction, treated at Yale University School of Medicine, New Haven, CT (published 1999)
• Exposure: Not reported. The article gives no asbestos or other occupational or environmental exposure history for this patient.
• Main results:
  • In this patient, the pulmonary artery catheter could not be advanced beyond 20 cm after induction of anesthesia.
  • In this patient, transesophageal echocardiography showed a mass almost occluding the right atrial cavity.
  • The ultrasound findings could not distinguish whether the mass was inside or outside the heart.
  • After the pericardium was peeled off, a slab of tissue was found overlying the ascending aorta, right atrium and right ventricle. It was completely resected.
  • Final pathology confirmed a pericardial mesothelioma in this patient.
  • After surgery the patient developed a catheter-related bloodstream infection with methicillin-resistant Staphylococcus aureus.
  • The patient was discharged home on postoperative day 35.
  • Background statement from the introduction, citing earlier literature (reference 1), not a finding of this case: primary malignant mesothelioma accounts for 4% of primary cardiac tumors and, unlike pleural mesothelioma, has not been linked to asbestos exposure.
• The authors' conclusion: The authors concluded that the case illustrates what transesophageal echocardiography can contribute, beyond monitoring, to the diagnosis and intraoperative management of patients found at surgery to have unusual incidental findings.

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, Pericardium, Pathology, Differential Diagnosis, Asbestos Exposure.

Related studies

• Malignant pericardial mesothelioma. Report of two cases, review of the literature and differential diagnosis — M. Papi, G. Genestreti, et al. (2005)
• Timely diagnosis of primary pericardial mesothelioma — H.C. Chen, S. Chang, et al. (2020)
• Pericardial mesothelioma and asbestos exposure — C. Mensi, S. Giacomini, et al. (2011)
• Primary malignant pericardial mesothelioma mimicking pericardial metastasis from adenocarcinoma — M. Horie, S. Noguchi, et al. (2010)
• Primary malignant pericardial sarcomatoid mesothelioma: An autopsy report — H. Muta, Y. Sugita, et al. (2017)
• Fibrolipoma of the left ventricle: an uncommon incidental autopsy finding — K. Fragkouli, A. Mitselou, et al. (2020)

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