A Rare Cause of Constrictive Pericarditis: Primary Pericardial Mesothelioma

Our plain-English summary of A Rare Cause of Constrictive Pericarditis: Primary Pericardial Mesothelioma, by K. Ravindra, C. Vanchiere, V.A. Ferrari (JACC. Case Reports, 2025).

The study

• Authors: K. Ravindra, C. Vanchiere, V.A. Ferrari
• Journal: JACC. Case Reports
• Published: 2025;30(16):103802
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

This clinical vignette highlights the use of echocardiography, computed tomography, positron emission tomography, magnetic resonance imaging, and invasive hemodynamics to aid in making a rare diagnosis. This case highlights a 62-year-old male who presented with worsening dyspnea and was ultimately found to have constrictive pericarditis secondary to primary pericardial mesothelioma. The use of multimodality imaging can facilitate early diagnosis of this rare condition, helping to initiate treatment options for an otherwise high-mortality disease.

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

In plain English

This was a report on a single patient at the Hospital of the University of Pennsylvania. A 62-year-old man came in with worsening shortness of breath. At age 29 he had been treated with chemotherapy for Hodgkin's lymphoma, and at age 59 he had had an inflamed, bloody fluid collection around the heart. Several tests together showed a thickened, stiffened sac around the heart (constrictive pericarditis): heart ultrasound, CT, PET, cardiac MRI and a right heart catheter test. The PET scan was at first read as compatible with returning lymphoma. During surgery to remove the heart sac, surgeons found hard, tumor-like growths invading the heart muscle. They stopped after a biopsy and limited tumor removal. The biopsy showed low-grade epithelioid type malignant mesothelioma. With no disease in the lungs or elsewhere, the diagnosis was primary pericardial mesothelioma. The authors reported that the patient had neither of the mesothelioma risk factors they named, asbestos or ionizing radiation. Chemotherapy was not possible because of kidney problems, and hospice was chosen. The authors concluded that the case highlights the usefulness of combining imaging methods to confirm this difficult diagnosis.

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 62-year-old man treated at the Hospital of the University of Pennsylvania, Philadelphia, USA. He had a history of chemotherapy-treated Hodgkin's lymphoma at age 29 and an inflammatory hemorrhagic pericardial effusion at age 59, and presented with worsening dyspnea (shortness of breath).
• Exposure: The authors reported that the patient had neither of the mesothelioma risk factors they named (asbestos or ionizing radiation). He had never received mantle radiation therapy for his Hodgkin's lymphoma.
• Main results:
  • The patient's NT-proBNP, a blood marker of heart strain, was 3,628 pg/mL (normal below 124 pg/mL).
  • PET imaging showed hypermetabolic circumferential nodular thickening of the pericardium, which was initially read as compatible with recurrent lymphoma.
  • Cardiac MRI showed diffuse late gadolinium enhancement involving the thickened pericardium.
  • Right heart catheterization showed findings of constriction. These included a right ventricular systolic pressure of 30 mm Hg, a right ventricular diastolic pressure of 15 mm Hg, and a pulmonary capillary wedge pressure of 17 mm Hg.
  • During attempted radical pericardiectomy, hard, tumor-like projections from the pericardium were found invading the myocardium (heart muscle).
  • Surgery was stopped after an intraoperative biopsy and limited tumor resection.
  • The biopsy showed low-grade epithelioid type malignant mesothelioma.
  • No disease was found in the lungs or outside the heart, which the authors said confirmed primary pericardial mesothelioma.
  • Chemotherapy was not possible because of the patient's kidney dysfunction, and hospice was chosen.
• The authors' conclusion: The authors concluded that the case highlights the usefulness of multimodality imaging (several imaging methods together) to confirm a challenging diagnosis.

Topics

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

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)
• Malignant primary pericardial mesothelioma presenting as effusive constrictive pericarditis: a case report study — A. Savarrakhsh, A. Vakilpour, et al. (2021)
• Constrictive Pericarditis Caused by Primary Pericardial Mesothelioma: A Case Series — T.A. Meijs, J.F. Heidendael, et al. (2024)
• Primary malignant pericardial mesothelioma presenting as constrictive pericarditis with an atypical imaging appearance: a case description — Y. Chen, X. Ren, et al. (2023)
• Primary Pericardial Mesothelioma Causing Constrictive Pericarditis — S.T. Luebbe, Q. Youmans, et al. (2025)
• Primary Malignant Pericardial Mesothelioma Manifesting as Constrictive Pericarditis with Atypical Imaging Features: A Case Report — E. Shahverdi, G. Santhosh Kumar, et al. (2026)

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