Pericardial Effusion due to Primary Malignant Pericardial Mesothelioma: A Common Finding but an Uncommon Cause

Our plain-English summary of Pericardial Effusion due to Primary Malignant Pericardial Mesothelioma: A Common Finding but an Uncommon Cause, by V. Istomin, D.S. Blondheim, S.R. Meisel, et al (Case Reports in Medicine, 2016).

The study

• Authors: V. Istomin, D.S. Blondheim, S.R. Meisel, A. Frimerman, M. Lapidot, R. Rachmilevitch
• Journal: Case Reports in Medicine
• Published: 2016;2016:4810901
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

This case report describes a 37-year-old female who was admitted to our Emergency Department because of shortness of breath. On physical examination, she had dyspnea and tachycardia and blood pressure was 80/50 mmHg with a pulsus paradoxus of 22 mmHg. Neck veins were distended, heart sounds were distant, and dullness was found on both lung bases. Her chest X-ray revealed bilateral pleural effusion and cardiomegaly. On both computed tomography and echocardiography the heart was of normal size and a large pericardial effusion was noted. The echocardiogram showed signs of impending tamponade, so the patient underwent an emergent pericardiocentesis. No infectious etiology was found and she was assumed to have viral pericarditis and was treated accordingly. However, when the pericardial effusion recurred and empirical therapy for tuberculosis failed, a pericardial window was performed. A typical staining pattern for mesothelioma was found on her pericardial biopsy specimen. Since no other mesodermal tissue was affected, a diagnosis of primary malignant pericardial mesothelioma was made. Chemotherapy was not effective and she passed away a year after the diagnosis was made. This case highlights the difficulties in diagnosing this uncommon disease in patients that present with the common finding of pericardial effusion.

In plain English

This was a case report of one 37-year-old woman who had immigrated to Israel from Ethiopia. She was admitted with new shortness of breath and signs of cardiac tamponade, a buildup of fluid around the heart that presses on it. Doctors drained 770 cc of bloody fluid from the sac around her heart. No germs, tuberculosis bacilli or cancer cells were found in it. Benign pericarditis (inflammation of that sac) was suspected, and she was treated with ibuprofen and colchicine. Three months later the fluid returned and 1200 cc was drained. Only reactive mesothelial cells were seen. Tuberculosis was then suspected and treated, but the fluid built up again within 4 weeks. A biopsy taken during surgery showed tumor cells that stained in a pattern consistent with primary malignant mesothelioma. Because the pericardium was the only such tissue with cancer, she was diagnosed with primary malignant pericardial mesothelioma. She denied any known contact with asbestos. Despite chemotherapy, she died a year later. The authors concluded that this cancer should be suspected when fluid around the heart keeps returning despite anti-inflammatory treatment.

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 (one patient)
• Who was studied: One 37-year-old woman who had immigrated to Israel from Ethiopia, treated at Hillel Yaffe Medical Center, Hadera, Israel; dates of care not given
• Exposure: No asbestos exposure was identified; the patient denied any known contact with asbestos. No fiber type is reported.
• Main results:
  • At the first emergency drainage, 770 cc of bloody fluid was removed from around the patient's heart.
  • Cultures of this first fluid were sterile, and no acid fast bacilli or malignant cells were found in it.
  • Benign pericarditis was suspected, and the patient was treated with ibuprofen and colchicine for 16 weeks.
  • Three months later the effusion recurred, and 1200 cc of sterile bloody fluid was drained.
  • Tuberculous pericarditis was suspected and treated empirically, but the fluid built up again within 4 weeks.
  • The pericardial biopsy stained strongly positive for Cytokeratin and Calretinin in tumor cells, consistent with primary malignant mesothelioma.
  • Primary malignant pericardial mesothelioma was diagnosed because the pericardium was the only mesothelial tissue in which malignant cells were found.
  • The patient died a year later despite chemotherapy.
• The authors' conclusion: The authors concluded that primary malignant pericardial mesothelioma should be suspected in patients whose pericardial effusion keeps returning despite appropriate anti-inflammatory treatment.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Effusion, Pericardial Mesothelioma, Dyspnea, Chest X-Ray, Bilateral, Pleural Effusion, Echocardiogram, Pericardiocentesis.

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)
• A Rare Cause of Constrictive Pericarditis: Primary Pericardial Mesothelioma — K. Ravindra, C. Vanchiere, et al. (2025)
• Surprising finding of a primary pericardial mesothelioma — J. Vavalle, T.M. Bashore, et al. (2010)
• Multimodality imaging of common and uncommon peritoneal diseases: a review for radiologists — R.A. Vicens, M. Patnana, et al. (2015)
• Multiple serous membrane effusion caused by primary pericardial mesothelioma — B.T. Dung, N.T. Hien, et al. (2023)
• 18F-fluorodeoxyglucose imaging of primary malignant pericardial mesothelioma with concurrent pericardial and pleural effusions and bone metastasis: A case report — X. Li, R. Lu, et al. (2018)

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