Intermittent Superior Vena Cava Syndrome Secondary to Malignant Pericardial Mesothelioma

Our plain-English summary of Intermittent Superior Vena Cava Syndrome Secondary to Malignant Pericardial Mesothelioma, by S.A. Alwusaibie, J.S. Alsayigh, D. Alfaraj, et al (Curēus, 2020).

The study

• Authors: S.A. Alwusaibie, J.S. Alsayigh, D. Alfaraj, A.M. Alomair, S.A. Alsaeed
• Journal: Curēus
• Published: 2020;12(12):e12107
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pericardial sarcomatoid mesothelioma is a massively rare tumor accounting for 0.8% of all cases of mesothelioma. Superior vena cava syndrome (SVCS) occurs due to a partial obstruction or compression to the superior vena cava, which hinders the blood outflow to the upper body. It can be caused by an intrinsic factor such as thrombosis, or by an extrinsic factor such as tumors. Clinical presentation includes edema of the face and upper limbs, plethora, dyspnea, dysphagia, stridor and cough. we are reporting a case of a 56-year-old female, who is a known case of hypertension on angiotensin-converting enzyme inhibitors (ACEIs). Presented to the emergency department with intermittent facial swelling and dyspnea. Imaging and pathology reports confirmed the diagnosis of intermittent SVCS secondary to pericardial sarcomatoid mesothelioma with pericardial effusion. What makes our case unique is that both the etiology and the presenting complaint are rare entities, as most SVCS cases are continuously symptomatic throughout the disease course, and are usually caused by a lung cancer or lymphoma.

Copyright © 2020, Alwusaibie et al.

In plain English

This case report described one patient. A 56-year-old woman with high blood pressure and high cholesterol came to the emergency department of a tertiary hospital with one week of facial swelling that came and went, and shortness of breath on exertion. The swelling was worst in the morning. She had lost about 10 kg in two months and had made multiple earlier emergency visits for the same complaint. A CT scan showed soft tissue surrounding the superior vena cava, the large vein that drains the head, neck and arms, which was markedly narrowed. It also showed fluid around the heart. During a biopsy operation, surgeons found a mass inside the pericardium, the sac around the heart. A pulmonary artery was injured, she had two cardiac arrests, and she died. The tissue findings were described as highly suggestive of sarcomatoid mesothelioma. The authors concluded that the most likely cause of her symptoms was pericardial mesothelioma with malignant pericardial effusion, and that superior vena cava syndrome can rarely cause intermittent symptoms. The article did not report whether she had been exposed to asbestos.

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 of a single patient, with a brief comparison to four previously published cases found through a PubMed search
• Who was studied: One 56-year-old woman with hypertension and dyslipidemia for more than 10 years, seen at the emergency department of a tertiary hospital. The authors are affiliated with King Fahad University Hospital, Al Khobar, Saudi Arabia.
• Exposure: Not reported. The article does not describe any asbestos or other occupational exposure for this patient. The statement of no asbestos exposure in the article refers to a different, previously published case, not this patient.
• Main results:
  • The patient had intermittent facial swelling and exertional dyspnea for one week. Her face was markedly swollen in the morning and only minimally swollen around the eyes by the end of the day.
  • She reported weight loss of around 10 kg over two months, and multiple earlier emergency visits for the same complaint, at each of which she was investigated, reassured and discharged.
  • Laboratory tests showed microcytic hypochromic anemia, with hemoglobin of 8.7 g/dl (normal 12-16 g/dl).
  • Chest X-ray and echocardiogram suggested a moderate pericardial effusion. CT showed low-density soft tissue in the prevascular space surrounding the superior vena cava, which was markedly narrowed.
  • At video-assisted thoracoscopic surgery on day five of admission, 200cc of hemorrhagic pericardial fluid was drained and a mass was found within the pericardium compressing the left atrium. The pulmonary artery was injured, the patient had two cardiac arrests, and she was declared dead at the end of the procedure.
  • Histopathology was positive for pan CK, CK7 and calretinin, and focally weakly positive for D2-40 and CD56. Ki67 was high at 70%. This was reported as highly suggestive of a sarcomatoid mesothelioma.
• The authors' conclusion: The authors concluded that the most likely cause of the patient's symptoms was pericardial mesothelioma with malignant pericardial effusion. They also concluded that superior vena cava syndrome can rarely present with intermittent symptoms, should be ruled out before other diagnoses, and that mesothelioma can be a rare cause of this presentation.

Topics

Medical terms in this study, explained in our Lexicon: Superior Vena Cava Syndrome, Pericardial Mesothelioma, Pericardial, Sarcomatoid, Mesothelioma, Dyspnea, Dysphagia, Pathology Report.

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