Primary Pericardial Mesothelioma Causing Constrictive Pericarditis

Our plain-English summary of Primary Pericardial Mesothelioma Causing Constrictive Pericarditis, by S.T. Luebbe, Q. Youmans, T. Provias, et al (JACC. Case Reports, 2025).

The study

• Authors: S.T. Luebbe, Q. Youmans, T. Provias, A. Lewis, P.C. Cremer, F. Obeidin, K. Merchant, D.R. Johnston, M. Al-Kazaz
• Journal: JACC. Case Reports
• Published: 2025;30(8):103204
• Read it: PubMed · Publisher · Free full text

Abstract

We present a rare case of primary pericardial mesothelioma (PPM) causing constrictive pericarditis (CP). Our case highlights the importance of identifying the etiology of constriction and the role of multimodality imaging in CP. PPM is a primary pericardial malignancy and an unusual cause of CP that carries a grave prognosis despite pericardiectomy and/or chemotherapy. PPM can be difficult to diagnose and should be considered as a possibility when there is no other clear etiology of CP.

Copyright © 2025 The Authors. Published by Elsevier Inc. All rights reserved.

In plain English

This article was a case report about one patient: a 74-year-old woman with high blood pressure and atrial fibrillation who had shortness of breath on exertion. Four months earlier she had been treated with naproxen and prednisone for acute pericarditis, which is inflammation of the sac around the heart. Since then she had been hospitalized three times for heart failure. Heart ultrasound showed signs of constrictive pericarditis, in which a stiffened sac squeezes the heart. These signs included an elevated medial e-prime velocity, pericardial thickening and septal bounce. Her condition progressed to cardiogenic shock, and she needed emergency surgery to remove the pericardium. Surgeons found intense thickening and adhesions invading the heart muscle but no clear mass. Tissue examination showed primary pericardial mesothelioma. The article did not describe any asbestos exposure for this patient. Citing an earlier published review, the authors wrote that, unlike pleural mesothelioma, this cancer has no clear association with asbestos exposure. The authors concluded that this cancer is a rare cause of constrictive pericarditis and that prognosis remains poor despite 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 74-year-old woman with hypertension and atrial fibrillation who presented with shortness of breath on exertion and possible worsening heart failure; place and dates of care not stated
• Exposure: Not reported; the article gives no asbestos or other exposure history for this patient
• Main results:
  • Four months before presentation the patient had been treated with naproxen and prednisone for acute pericarditis, and since then she had been hospitalized 3 times for heart failure
  • The patient's brain natriuretic peptide level was 465 pg/mL
  • In this patient, elevated medial e-prime velocity on echocardiography was consistent with constrictive pericarditis, and imaging also showed pericardial thickening and septal bounce
  • The patient was diagnosed with constrictive pericarditis and progressed to cardiogenic shock
  • After pericardiectomy (surgical removal of the pericardium), pathology showed primary pericardial mesothelioma
  • At surgery the patient had intense pericardial thickening and adhesions invading the heart muscle, with no clear mass seen on imaging or at surgery
  • Background statement drawn from a cited published review, not a finding of this case: unlike pleural mesothelioma, primary pericardial mesothelioma has no clear association with asbestos exposure
• The authors' conclusion: The authors concluded that primary pericardial mesothelioma is a rare cause of constrictive pericarditis, that multimodality imaging is crucial for diagnosis, and that prognosis remains poor despite treatment

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Etiology, Pericardial, Prognosis, Pericardiectomy, Chemotherapy.

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