Large pericardial mesothelial cyst coexisting with hypertrophic obstructive cardiomyopathy

Our plain-English summary of Large pericardial mesothelial cyst coexisting with hypertrophic obstructive cardiomyopathy, by A. Sadeghpour, A. Alizadeh-Ghavidel, K. Mozaffari, et al (ARYA Atherosclerosis, 2020).

The study

• Authors: A. Sadeghpour, A. Alizadeh-Ghavidel, K. Mozaffari, H. Pouraliakbar, B. Ghadrdoost, M. Behjati
• Journal: ARYA Atherosclerosis
• Published: 2020;16(2):102-104
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Pericardial mesothelioma cyst occurs rarely, and is often found incidentally. The coexistence between large pericardial mesothelial cyst and hypertrophic obstructive cardiomyopathy (HOCM) can make difficulties in medical management.

Case Report: Our case was a 33-year-old man presented with dizziness and pallor while standing since four years before, and recent syncope. On admission, transthoracic echocardiography reveled presence of hypertrophic cardiomyopathy in association with relatively small right ventricular and atrium due to compression effect by a large echo-free space at the right side of heart suggestive of pericardial cyst. Cardiac computed tomography confirmed presence of HOCM and large pericardial cyst. Patient underwent surgical septal myectomy and large mesothelial pericardial cyst excision because of persistent symptoms and compression effect of cyst on the right chambers despite beta-blocker therapy.

Conclusion: To best of our knowledge, the coexistence of the large pericardial mesothelial cyst and HOCM has not been reported before.

© 2020 Isfahan Cardiovascular Research Center & Isfahan University of Medical Sciences.

In plain English

This article was a case report from authors at the Rajaie Cardiovascular Medical and Research Center in Tehran, Iran. It described one 33-year-old man. For four years he had felt dizzy and pale when standing, and he was admitted after fainting and injuring his face. His father had died of sudden cardiac death at age 43. Heart ultrasound showed hypertrophic obstructive cardiomyopathy (HOCM), a thickened heart muscle that blocks blood leaving the heart, with a resting gradient of 64 mmHg. It also showed a large fluid-filled space pressing on the right side of the heart. A CT scan confirmed HOCM and a large pericardial cyst. Symptoms persisted despite beta-blocker therapy, so surgeons removed part of the thickened septum and the cyst, whose pieces measured 12 × 12 × 3 cm. Under the microscope it was a thin-walled cyst lined by a single layer of cells, consistent with a mesothelial cyst, which the authors note is also called benign cystic mesothelioma. The authors concluded that, to their knowledge, this combination had not been reported before. The article does not mention 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 (single patient)
• Who was studied: One 33-year-old man with dizziness and pallor on standing for four years and recent syncope; the authors are based at Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
• Main results:
  • The patient had dizziness and pallor while standing for four years; the last episode included syncope and facial trauma, leading to admission
  • Family history: his father had sudden cardiac death at age 43
  • Transthoracic echocardiography showed HOCM with a maximal late-peaking gradient at rest of 64 mmHg
  • The right ventricle was relatively small because a large echo-free space beside the right side of the heart was compressing it
  • Cardiac CT confirmed HOCM and identified the echo-free space as a large pericardial cyst
  • Surgery (septal myectomy and cyst excision) was done because of persistent symptoms and the cyst pressing on the right heart chambers despite beta-blocker therapy
  • At surgery the cyst was attached to the pericardium and extended entirely into the right pleural space
  • The excised cystic pieces measured 12 × 12 × 3 cm, with a smooth inner wall about 1 mm thick, consistent with a mesothelial cyst
  • Under the microscope it was a thin-walled cyst lined by a single layer of non-pleomorphic cells
• The authors' conclusion: The authors concluded that, to their knowledge, the coexistence of a large pericardial mesothelial cyst and HOCM had not been reported before. They said it makes medical management difficult, because high-dose beta-blockers would be risky when a large cyst is compressing the right heart chambers, and that a possible common genetic origin could be assessed.

Topics

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

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