Primary cardiac pericardial mesothelioma-a rare but deadly disease: a case description

Our plain-English summary of Primary cardiac pericardial mesothelioma-a rare but deadly disease: a case description, by M. Meter, D. Glavaš, D. Radović, et al (Quantitative Imaging in Medicine and Surgery, 2025).

The study

• Authors: M. Meter, D. Glavaš, D. Radović, D. Meter, J. Gabrić
• Journal: Quantitative Imaging in Medicine and Surgery
• Published: 2025;15(11):11689-11694
• Type of article: Letter
• Read it: PubMed · Publisher · Free full text

In plain English

This letter to the editor was a case report describing one patient with suspected primary pericardial mesothelioma, a cancer of the lining around the heart. A 54-year-old man came to the emergency department with cough, tiredness and shortness of breath lasting 20 days. Scans showed a blood clot in the lung and a large fluid collection around the heart. Doctors drained 2.5 liters of bloody fluid, and testing of the cells showed intense, atypical growth of mesothelial cells. Three months later he returned with worse symptoms. Another 3,000 mL was drained. Scans showed growths on the pericardium, smaller active masses in the pleura and chest lymph nodes, and clots in veins of the arm and neck. He had no prior history of tuberculosis or occupational asbestos exposure. He declined a biopsy, so the diagnosis was not confirmed by tissue examination. He began chemotherapy with cisplatin and pemetrexed and was reported to be doing well after a second cycle. The authors concluded that the disease should be considered when pericardial fluid recurs, or constriction occurs, together with multiple unexplained vein clots.

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 (published as a letter to the editor)
• Who was studied: One 54-year-old man who came to the emergency department with cough, malaise, lethargy and shortness of breath lasting 20 days. The authors were from Split University Hospital, Croatia.
• Exposure: None reported. The patient had no prior history of tuberculosis or occupational asbestos exposure. No fiber types were discussed for this patient.
• Main results:
  • At first presentation, CT pulmonary angiography showed a right lobar/segmental pulmonary embolism and a significant pericardial effusion measuring 40 mm.
  • The first pericardiocentesis removed 2.5 liters of hemorrhagic fluid. Cytology showed intense and atypical growth of mesothelial cells.
  • When readmitted three months later, a second pericardiocentesis removed 3,000 mL of hemorrhagic fluid. Repeat CT showed irregular growths on the pericardium.
  • Doppler imaging showed thrombosis in the subclavian, axillary and brachial veins and in the left internal jugular vein.
  • On FDG-PET, a mass in the visceral pericardium had a maximum SUV of 11.2. Smaller masses in the pleura and the paratracheal and supracarinal lymph nodes had a maximum SUV of 8.2.
  • The authors judged that the findings strongly indicated primary pericardial mesothelioma that had spread to the mediastinal lymph nodes and pleura.
  • The patient declined the recommended pericardial biopsy. He began chemotherapy with cisplatin 120 mg and pemetrexed 800 mg.
  • At follow-up the patient was doing well and had completed a second cycle of chemotherapy. Immunotherapy with nivolumab and ipilimumab was being considered.
• The authors' conclusion: The authors concluded that primary pericardial mesothelioma should be considered when pericardial effusion recurs, or signs of constriction occur, together with multiple venous thromboses of unclear cause. They added that multimodality imaging can be of crucial importance for early detection.
• Limitations the authors state:
  • The diagnosis lacked pathohistological (tissue) confirmation and rested on cytology results the authors called highly suggestive.
  • The patient declined the diagnostic pericardial biopsy that the multidisciplinary team had recommended.

Topics

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

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