Multiple serous membrane effusion caused by primary pericardial mesothelioma

Our plain-English summary of Multiple serous membrane effusion caused by primary pericardial mesothelioma, by B.T. Dung, N.T. Hien, N.H. Dinh, et al (Radiology Case Reports, 2023).

The study

• Authors: B.T. Dung, N.T. Hien, N.H. Dinh, N.Q. Dat, L.M. Khoi, T. Hoa, T.B. Hieu, N.M. Duc
• Journal: Radiology Case Reports
• Published: 2023;18(9):2903-2906
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Primary pericardial mesothelioma is an extremely rare cancer with a short survival prognosis. Clinical symptoms are often atypical, and most patients are diagnosed after surgery or at autopsy. We report a case of a 35-year-old female patient with multiple serous membrane effusion for more than 1 year. The patient underwent pericardial, pleural, and peritoneal fluid drainage many times and underwent many laboratory tests to find the cause; however, there was no definitive diagnosis. She was admitted to the hospital because of shortness of breath, cough, and sputum for 5 days. She underwent extensive pericardiectomy to resolve the dyspnea and pericardial surgery to find the cause of the multiple serous membrane effusion. After surgery, her dyspnea was relieved, and the serous effusion gradually decreased.

© 2023 The Authors. Published by Elsevier Inc. on behalf of University of Washington.

In plain English

This case report from Vietnam described a 35-year-old female pharmacist with no history of heart disease or cancer. For more than a year, starting in November 2019, fluid kept building up around her heart, lungs and abdomen. She had the fluid drained many times and underwent many tests, including pleural and lymph node biopsies, none showing cancer. She was at first diagnosed with Demons–Meigs syndrome, but after referral to an obstetrics and gynecology hospital no diagnosis was confirmed. In November 2020, scans showed irregular thickening of the pericardium (the sac around the heart). She was diagnosed with constrictive pericarditis likely due to malignancy. At surgery to remove the pericardium, it was 10 mm thick, and tissue staining showed malignant mesothelioma. After surgery her breathlessness eased. She chose not to have chemotherapy and was discharged after 3 weeks. She did not return for follow-up, and lung metastases were suspected on a CT scan. The authors reported that she had no history of asbestos exposure. They concluded that doctors should be aware of all signs in patients with pericardial effusion, especially imaging findings.

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
• Who was studied: One 35-year-old female pharmacist in Vietnam with no previous history of cardiovascular disease or malignancy, followed from November 2019 to late 2020
• Exposure: The authors report that the patient had no history of asbestos exposure
• Main results:
  • Over more than a year of repeated fluid drainage and testing, a left supraclavicular lymph node biopsy and a second right pleural biopsy did not show malignancy
  • After a multidisciplinary consultation she was at first diagnosed with Demons–Meigs syndrome. She was then referred to an obstetrics and gynecology hospital, and no diagnosis was confirmed there
  • CT in November 2020 showed irregular pericardial thickening, up to 10 mm
  • At surgery the pericardium was 10 mm thick, and immunohistochemical staining showed malignant mesothelioma
  • After surgery her breathlessness was relieved and the fluid build-up gradually decreased
  • She declined chemotherapy and was discharged after 3 weeks
  • Lung metastases were suspected on the CT taken on November 24, 2020
• The authors' conclusion: The authors concluded that pericardial thickening on chest CT had been missed for 7 months, and that doctors should be aware of all signs in patients with pericardial effusion, especially imaging findings
• Limitations the authors state:
  • The patient did not return after discharge, so the authors could not follow her progress

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Prognosis, Autopsy, Pericardial, Sputum, Pericardiectomy, Dyspnea.

Related studies

• Use of antisera to epithelial membrane antigen for the cytodiagnosis of malignancy in serous effusions — A. To, D.V. Coleman, et al. (1981)
• Constrictive Pericarditis Caused by Primary Pericardial Mesothelioma: A Case Series — T.A. Meijs, J.F. Heidendael, et al. (2024)
• Primary pericardial mesothelioma presenting as multiple pericardial masses on CT — M.C. Raeside, K. Gormly, et al. (2016)
• Primary Pericardial Sarcoma with Right Atrial Invasion and Multiple Bilateral Pulmonary Metastases in a Patient with Hereditary Nonpolyposis Colorectal Cancer — E. Wong, L.J. Oh, et al. (2016)
• Transforming growth factor-beta 1 (TGF-beta 1)- and beta 2-like activities in malignant pleural effusions caused by malignant mesothelioma or primary lung cancer — J. Maeda, N. Ueki, et al. (1994)
• Primary malignant pericardial mesothelioma - a rare cause of pericardial effusion and consecutive constrictive pericarditis: a case report — T. Butz, L. Faber, et al. (2009)

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