Primary pericardial mesothelioma presenting as multiple pericardial masses on CT

Our plain-English summary of Primary pericardial mesothelioma presenting as multiple pericardial masses on CT, by M.C. Raeside, K. Gormly, S.J. Neuhaus, et al (BJR Case Reports, 2016).

The study

• Authors: M.C. Raeside, K. Gormly, S.J. Neuhaus, D. Kotasek, C. James
• Journal: BJR Case Reports
• Published: 2016;2(1):20150295
• Type of article: Case report
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

We present the case of a 67-year-old male who was found to have multiple enhancing pericardial masses on CT imaging for investigation of weight loss and was subsequently diagnosed with primary pericardial mesothelioma. Although rare, pericardial mesothelioma is the most common primary malignancy of the pericardium and should be considered in the differential diagnosis of pericardial effusion, pericardial thickening or discreet pericardial mass. It is important for radiologists to be aware of pericardial mesothelioma as its clinical presentation is non-specific and it may be incidentally noted on radiological studies for investigation of apparently non-related symptoms. The prognosis of primary pericardial mesothelioma is universally poor.

In plain English

This article is a case report about one patient, a 67-year-old man diagnosed with primary pericardial mesothelioma, a cancer of the lining around the heart. He had a CT scan of the chest, abdomen and pelvis to investigate loss of appetite, night sweats and about 10 kg of weight loss. The article records no history of significant occupational asbestos exposure, but says he may have been exposed to asbestos in farm outbuildings while working as a farmer. The CT showed multiple rim-enhancing, necrotic masses along the pericardium, narrowing the right main pulmonary artery. No pleural plaque, calcification or mass was seen. His blood calcium was raised at 3.6 mmol per litre (normal range 2.2 to 2.6), which the authors described as malignant hypercalcaemia. CT-guided core biopsies supported a diagnosis of desmoplastic mesothelioma, although the authors said this diagnosis was difficult to make. The masses could not be removed surgically. He received three cycles of pemetrexed and carboplatin chemotherapy, but the tumour grew slightly. He stopped chemotherapy and died about 4 months after diagnosis. The authors concluded that radiologists should be aware of this rare condition.

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 of a single patient
• Who was studied: One 67-year-old man, a farmer, referred for CT scanning because of anorexia, night sweats and about 10 kg weight loss
• Exposure: No history of significant occupational exposure such as asbestos, but possible asbestos exposure in farm outbuildings during his work as a farmer; no fiber type or dose is given
• Main results:
  • In this patient, CT showed multiple discrete rim-enhancing necrotic pericardial masses from just below the aortic arch to the diaphragm, with narrowing of the right main pulmonary artery and compression of the pulmonary veins
  • In this patient, no pleural plaque, calcification or mass was identified on CT
  • In this patient, blood calcium was 3.6 mmol per litre (normal range 2.2 to 2.6), consistent with malignant hypercalcaemia; parathyroid hormone related peptide was also elevated at 6.6 pmol per litre (normal range below 2)
  • In this patient, CT-guided core biopsy findings, immunocytochemistry and clinical and imaging correlation supported a diagnosis of desmoplastic mesothelioma
  • In this patient, the lesions were judged non-resectable. He was treated with pamidronate for hypercalcaemia and three cycles of chemotherapy
  • In this patient, a CT scan 3 months after diagnosis showed a slight increase in the pericardial malignancy and new bilateral pleural effusions
  • This patient stopped chemotherapy, was referred to palliative care, and died about 6 weeks later, 4 months after initial diagnosis
• The authors' conclusion: The authors concluded that radiologists should be aware of pericardial mesothelioma and consider it when they see pericardial effusion, pericardial thickening or pericardial masses, because its presentation is non-specific. They described its prognosis as universally poor and said that earlier diagnosis may potentially allow more definitive treatment.
• Limitations the authors state:
  • Because no fluid was drained from the pericardial effusion found about 12 months earlier, it was not possible to determine afterwards whether cancer was already present at that time
  • The authors stated that the biopsy diagnosis was difficult because of low cellularity, low-grade atypia and subtle tissue infiltration

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Pericardial, Pericardium, Differential Diagnosis, Pericardial Effusion, Prognosis.

Related studies

• Case Report: Extrapulmonary tuberculosis presenting as multiple caseous pericardial masses — J. Wang, R. Zhang, et al. (2025)
• Multiple serous membrane effusion caused by primary pericardial mesothelioma — B.T. Dung, N.T. Hien, et al. (2023)
• 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)
• 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 acute pericarditis — W.S. Choi, M.S. Im, et al. (2012)

Browse return to medical research.