Pericardial mesothelioma masquerading as a benign pericardial effusion

Our plain-English summary of Pericardial mesothelioma masquerading as a benign pericardial effusion, by N.L. Coplan, A.J. Kennish, N.L. Burgess, et al (Journal of the American College of Cardiology, 1984).

The study

• Authors: N.L. Coplan, A.J. Kennish, N.L. Burgess, L. Deligdish, M.E. Goldman
• Journal: Journal of the American College of Cardiology
• Published: 1984;4(6):1307-10
• Type of article: Case report
• Cited by: 13 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

A 53 year old asymptomatic man presented with a primary pericardial mesothelioma masquerading as a benign pericardial effusion. Although M-mode echocardiography showed an echo-free space, two-dimensional echocardiography and thoracic computed tomography demonstrated that the suspected effusion was caused by a mass surrounding the heart. Newer noninvasive techniques can be valuable for the early detection of pericardial tumor.

In plain English

This case report from Mount Sinai Medical Center, New York, described a 53-year-old man with primary pericardial mesothelioma, a cancer of the heart's outer sac. He reportedly did not smoke and had no asbestos exposure. A sore throat and cough were diagnosed as an upper respiratory tract infection, but a chest X-ray showed an enlarged heart outline and an M-mode echocardiogram was read as fluid around it. Some other causes were excluded, so the apparent fluid was attributed to a viral process, though he had never had symptoms of a generalized viral syndrome or pericarditis. He felt well, but over 6 months the enlarged heart and apparent fluid space grew. No fluid could be drained, and a two-dimensional echocardiogram showed solid tissue surrounding the heart. At surgery, tumor totally encased the heart; the final diagnosis was mesothelioma, epithelial type. He was referred for chemotherapy, then became progressively short of breath and tired. The authors concluded this tumor may go long without symptoms and mimic fluid on X-ray and M-mode echocardiography, but is easily distinguished from fluid by two-dimensional echocardiography.

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 53-year-old white man, described as asymptomatic, seen at Mount Sinai Medical Center, New York. His M-mode echocardiogram was in August 1983 and his two-dimensional echocardiogram was in February 1984.
• Exposure: The article reports that the patient had no exposure to asbestos and did not smoke cigarettes. No fiber type or job exposure is described.
• Main results:
  • The patient first went to his physician with a sore throat and a nonproductive cough of short duration. These were diagnosed as an upper respiratory tract infection. A chest X-ray then showed an enlarged cardiac silhouette.
  • After several possible causes were excluded by history and tests, the apparent pericardial effusion seen on M-mode echocardiography was attributed, by exclusion, to a viral process. A viral cause was not established.
  • The authors noted that the patient had never had symptoms of a generalized viral syndrome or pericarditis.
  • Over a 6-month follow-up period, the patient showed progressive enlargement of the heart and an increase in the echo-free space.
  • No fluid could be drawn off. Two-dimensional echocardiography showed that the space read as fluid on M-mode was echo-dense tissue surrounding the heart.
  • At surgery, tumor totally encased the heart and invaded the epicardium. Mediastinal lymph nodes appeared involved, and the tumor had not extended into the lung.
  • A frozen section was first interpreted as probable poorly differentiated adenocarcinoma. Further analysis, including electron microscopy, supported a final diagnosis of mesothelioma, epithelial type.
  • Because the tumor was extensive, the patient was referred for chemotherapy. Since discharge he had become progressively symptomatic with shortness of breath (dyspnea) and fatigue.
• The authors' conclusion: The authors concluded that primary pericardial mesothelioma may have a long asymptomatic period while the tumor enlarges. It may mimic a pericardial effusion on chest X-ray and M-mode echocardiography, but can be easily differentiated from fluid by two-dimensional echocardiography. They recommended early two-dimensional echocardiography for patients with a persistent pericardial effusion or one of unclear origin.

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, Pericardial Effusion, Pericardial.

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