Primary pericardial mesothelioma complicated by pericardial calcification

Our plain-English summary of Primary pericardial mesothelioma complicated by pericardial calcification, by J. Zhang, D. Liu, D. Zhang, et al (BMC Cardiovascular Disorders, 2023).

The study

• Authors: J. Zhang, D. Liu, D. Zhang, K. Guo, X. Yang
• Journal: BMC Cardiovascular Disorders
• Published: 2023;23(1):125
• Type of article: Case report
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: Pericardial calcification is usually a marker of chronic diseases, and its occurrence in rapidly progressing malignant primary pericardial mesothelioma (PPM) is extremely rare. Therefore, this atypical imaging appearance contributes to more frequent misdiagnosis of PPM. However, no systematic summary currently exists of the imaging characteristics of malignant pericardial calcification in PPM. In our report, its clinical characteristics are discussed in detail, to provide a reference to reduce the misdiagnosis rates of PPM.

Case Presentation: A 50-year-old female patient was admitted to our hospital, presenting primarily with features suggestive of cardiac insufficiency. Chest computed tomography revealed significant pericardial thickening and localized calcification, suspicious of constrictive pericarditis. A chest examination performed through a midline incision showed a chronically inflamed and easily-ruptured pericardium that was closely adherent to the myocardium. Post-operative pathological examination confirmed a diagnosis of primary pericardial mesothelioma. Six weeks postoperatively, the patient experienced symptom recurrence and abandoned chemotherapy and radiation therapy. Nine months postoperatively, the patient died of heart failure.

Conclusion: We report this case to highlight the rare finding of pericardial calcification in patients with primary pericardial mesothelioma. This case illustrated that confirmation of pericardial calcification cannot completely rule out rapidly developing PPM. Therefore, understanding the different radiological features of PPM can help to reduce its rate of early misdiagnosis.

© 2023. The Author(s).

In plain English

This was a case report from the Affiliated Hospital of Zunyi Medical University in China. It described one 50-year-old woman with primary pericardial mesothelioma, a cancer of the lining around the heart. The article states she had no history of asbestos exposure or tuberculosis. She had shortness of breath, fatigue and swelling of both legs. At a local hospital, more than 1200 mL of dark red fluid had been drained from around her heart. A chest CT scan showed the pericardium thickened to 25 mm with multiple calcifications, and doctors first considered tuberculous constrictive pericarditis. She had surgery to remove part of the pericardium. Tissue examination confirmed primary malignant epithelioid pericardial mesothelioma. Her symptoms improved after surgery but worsened again six weeks later. She abandoned chemotherapy and radiation therapy and died of heart failure nine months after surgery. The authors wrote that calcification is extremely rare in this cancer. They concluded that finding calcification cannot completely rule it out. They listed warning signs that, in their words, cannot confirm the diagnosis.

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 50-year-old female patient treated at the Department of Cardiac Macrovascular Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou Province, China; dates of care not stated
• Exposure: The article states the patient had no history of asbestos exposure (or tuberculosis); no fiber exposure was studied
• Main results:
  • Before referral, more than 1200 mL of dark red pericardial fluid was drained from the patient by ultrasound-guided pericardiocentesis at a local hospital
  • Chest CT in this patient showed pericardial thickening of 25 mm and multiple pericardial calcifications along the left lateral wall; a preliminary diagnosis of tuberculous constrictive pericarditis was considered
  • After partial pericardiectomy, the patient's central venous pressure dropped from 26 to 7 cm H2O, and fatigue and shortness of breath improved
  • Pathology of the removed tissue confirmed primary malignant epithelioid pericardial mesothelioma, with focal calcifications seen under the microscope and a Ki67 hotspot index of 60%
  • Six weeks after surgery the patient's symptoms of cardiac insufficiency worsened again. She abandoned chemotherapy and radiation therapy and died of heart failure nine months after surgery
• The authors' conclusion: The authors concluded that pericardial calcification, although extremely rare in primary pericardial mesothelioma, cannot completely rule it out. They listed warning signs that they said cannot confirm the diagnosis but may reduce misdiagnosis as benign pericardial calcification

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

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

Related studies

• A Rare Pericardial Malignancy — U. Fatima, S. Gupta, et al. (2016)
• Recurrent Tumor Suppressor Alterations in Primary Pericardial Mesothelioma — I.M. Schaefer, A. Mariño-Enríquez, et al. (2023)
• Primary pericardial mesothelioma: a case report of a patient treated with an immune checkpoint inhibitor as the second-line treatment — O. Arponen, V. Salo, et al. (2021)
• Malignant primary pericardial mesothelioma presenting as effusive constrictive pericarditis: a case report study — A. Savarrakhsh, A. Vakilpour, et al. (2021)
• Primary pericardial mesothelioma: report of two cases and review of the literature — A.L. Sytman, R.N. MacAlpin (1971)
• Pericardial malignant mesothelioma diagnosed in a dog by immunocytochemistry of the pericardial fluid: a case report — E.W. Choi (2023)

Browse return to medical research.