Primary malignant pericardial mesothelioma presenting as acute pericarditis

Our plain-English summary of Primary malignant pericardial mesothelioma presenting as acute pericarditis, by W.S. Choi, M.S. Im, J.H. Kang, et al (Journal of Cardiovascular Ultrasound, 2012).

The study

• Authors: W.S. Choi, M.S. Im, J.H. Kang, Y.G. Kim, I.C. Hwang, J.M. Lee, S. Lee, H.S. Shin, S.P. Lee, G.Y. Cho
• Journal: Journal of Cardiovascular Ultrasound
• Published: 2012;20(1):57-9
• Type of article: Case report
• Cited by: 8 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

We report on a 21-year-old man with fever, dyspnea, and pleuritic chest pain. An electrocardiography showed ST elevation in multiple lead and thoracic echocardiography revealed moderate pericardial effusion. He was initially diagnosed with acute pericarditis, and treated with nonsteroidal anti-inflammatory drugs and colchicines with clinical and laboratory improvement. After 1 month of medication, his symptoms recurred. An echocardiography showed constrictive physiology and the patient was treated with steroid on the top of current medication. The patient had been well for 7 months until dyspnea and edema developed, when an echocardiography showed marked increased pericardial thickness and constriction. Pericardial biopsy was performed and primary malignant pericardial mesothelioma was diagnosed. Malignancy should be considered in the differential diagnosis of recurrent pericarditis.

In plain English

This case report from Seoul National University Hospital in Korea described a 21-year-old man who arrived with fever, shortness of breath and chest pain. Fluid had built up in the sac around his heart (pericardial effusion). Fluid drained from the sac showed no malignant cells. He was treated for presumed viral pericarditis, an inflammation of that sac, with anti-inflammatory drugs and colchicine, and he improved. His symptoms returned one month after discharge. A biopsy of the pericardium then showed chronic inflammation and a few atypical mesothelial cells, and he improved on high-dose steroids. After 7 months of treatment he was readmitted with weakness, chest pain, breathlessness and leg swelling. Imaging showed a markedly thickened, constricting pericardium. A repeat biopsy diagnosed malignant mesothelioma of the pericardium. Findings during that biopsy suggested the tumor had invaded the heart muscle. He refused palliative chemotherapy and died 2 months after diagnosis. The report did not mention asbestos or any other exposure history. The authors concluded that malignancy should be considered when pericarditis keeps coming back.

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 21-year-old man treated at Seoul National University Hospital, Korea
• Main results:
  • In this patient, cytology of the pericardial fluid drained at first admission was negative for malignant cells
  • In this patient, the first pericardial biopsy, taken when symptoms recurred one month after discharge, showed a few proliferating atypical mesothelial cells within inflamed tissue
  • In this patient, a chest CT after 4 days of high-dose steroid treatment showed improved pericardial effusion and normal pericardial thickness
  • In this patient, a repeat pericardial biopsy after 7 months of treatment diagnosed primary malignant pericardial mesothelioma
  • In this patient, operative findings during the biopsy suggested invasion of the heart muscle
  • The patient refused palliative chemotherapy and died 2 months after diagnosis
• The authors' conclusion: The authors concluded that malignancy should be considered in the differential diagnosis of recurrent pericarditis.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Dyspnea, Pleuritic Chest Pain, Pericardial Effusion, Pericardial, Biopsy, Differential Diagnosis.

Related studies

• Primary pericardial mesothelioma in a 19-year-old presenting as pericarditis — M.O. Kayatta, S.P. Dineen, et al. (2013)
• Malignant primary pericardial mesothelioma presenting as effusive constrictive pericarditis: a case report study — A. Savarrakhsh, A. Vakilpour, et al. (2021)
• Primary malignant pericardial mesothelioma presenting as constrictive pericarditis with an atypical imaging appearance: a case description — Y. Chen, X. Ren, et al. (2023)
• Pericardial Mesothelioma Presenting as Constrictive Pericarditis — B. Shrestha, R. Handa, et al. (2022)
• Primary cardiac mesothelioma presenting with fulminant recurrent pericarditis: a case report — S. Schwartzenberg, Y. Shapira, et al. (2023)
• 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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