A Malignant Case of Constrictive Pericarditis

Our plain-English summary of A Malignant Case of Constrictive Pericarditis, by J. Betancor, B. Xu, A. Kumar, et al (CASE, 2017).

The study

• Authors: J. Betancor, B. Xu, A. Kumar, C.D. Tan, E.R. Rodriguez, S.D. Flamm, C.R. Asher, A.L. Klein
• Journal: CASE
• Published: 2017;1(1):17-22
• Type of article: Case report
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

• Malignant mesothelioma of the pericardium presents with progressive constrictive pathophysiology. • Multimodality imaging provides advanced tissue characterization of unknown pericardial collections. • Pericardial tumors can mimic constrictive pericarditis.

In plain English

This case report, by Cleveland Clinic physicians, described a 74-year-old man with three months of worsening breathlessness, fatigue and swollen feet. His history included smoking, Hodgkin's lymphoma treated with radiation, and prostate cancer. Scans showed a collection surrounding the heart. Draining it removed 1 L of bloody fluid with no malignant cells, but he was readmitted several times. Later heart imaging, including cardiac magnetic resonance, suggested a tumor of the pericardium (the sac around the heart) that was constricting the heart. At surgery a tumor was removed, and pathology showed malignant mesothelioma of the pericardium, of the epithelioid type. He developed multiorgan failure and died on the eighth day after surgery. The article did not report any asbestos exposure for this patient. Its discussion, citing earlier reports, said asbestos exposure has been reported in some cases. The authors concluded that the case highlighted the importance of using several imaging methods in selected cases of constrictive pericarditis, so that rare conditions like this are correctly diagnosed.

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 man seen at the emergency department with progressive shortness of breath, fatigue and pedal edema; the authors were from the Cleveland Clinic, Cleveland, Ohio; published 2017
• Exposure: No asbestos or other fiber exposure is reported for this patient. His history included smoking, Hodgkin's lymphoma treated with radiation therapy, and prostate cancer treated with radical prostatectomy.
• Main results:
  • On CT, the pericardial collection had a mean density of 30–45 Hounsfield units, compared with 7 Hounsfield units for the right-sided pleural effusion, suggesting a highly proteinaceous collection
  • Pericardiocentesis yielded 1 L of bloody fluid with scant reactive mesothelial cells but no malignant cells
  • After discharge, the patient was readmitted several times over the following months with debilitating shortness of breath and signs of volume overload
  • Cardiac magnetic resonance tissue characterization (T2-weighted and delayed gadolinium imaging) supported the diagnosis of a pericardial tumor
  • At pericardiectomy a pericardial tumor was resected, and pathology showed a malignant mesothelioma of the epithelioid type, including a bulky 2.5-cm mass
  • The patient developed worsening multiorgan failure and died on postoperative day eight
• The authors' conclusion: The authors concluded that the case highlights the importance of incorporating multimodality cardiovascular imaging in selected cases of constrictive pericarditis, so that rare conditions such as primary malignant pericardial mesothelioma are appropriately diagnosed.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma, Pericardium, Pericardial.

Related studies

• Primary malignant pericardial mesothelioma - a rare cause of pericardial effusion and consecutive constrictive pericarditis: a case report — T. Butz, L. Faber, et al. (2009)
• Asbestos induced pericardial effusion and constrictive pericarditis — D. Davies, M.I. Andrews, et al. (1991)
• Chronic constrictive pericarditis associated with asbestosis — L. Fischbein, M. Namade, et al. (1988)
• Malignant primary pericardial mesothelioma presenting as effusive constrictive pericarditis: a case report study — A. Savarrakhsh, A. Vakilpour, et al. (2021)
• A case of malignant pericardial mesothelioma with constrictive pericarditis physiology misdiagnosed as pericardial metastatic cancer — M.J. Lee, D.H. Kim, et al. (2011)
• Pericardiectomy for treatment of neoplastic constrictive pericarditis — F. Buyukbayrak, E. Aksoy, et al. (2014)

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