Primary Pericardial Mesothelioma, Which Was Veiled by a Pleural Empyema: A Case Report and Review

Our plain-English summary of Primary Pericardial Mesothelioma, Which Was Veiled by a Pleural Empyema: A Case Report and Review, by M. Tajjiou, W. Wild, N. Sayed, et al (Case Reports in Surgery, 2019).

The study

• Authors: M. Tajjiou, W. Wild, N. Sayed, A. Flauaus, M. Divo, M. Schwarzbach
• Journal: Case Reports in Surgery
• Published: 2019;2019:2896810
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

This case report shows that pleural empyema limits the diagnostic significance of imaging techniques. Hereafter, we present the case of an 82-year-old patient with primary pericardial mesothelioma, which was veiled by a pleural empyema. The patient met the typical triad of signs of heart failure (dyspnea, lower leg oedema), pericardial effusion, and pericarditis. Echocardiography in the identification of pericardial mesotheliomas is low. In this case, the cardiac function could be imaged well, but the tumor could not be imaged. The CT showed a pericardial effusion and a pleural effusion. Here, the tumor could not be diagnosed either. Only the operation led to diagnosis.

Copyright © 2019 Morad Tajjiou et al.

In plain English

This article described the case of one 82-year-old man treated at a hospital in Frankfurt, Germany, followed by a short discussion of earlier reports. The patient came to the emergency room with worsening general condition, an 8 kg weight loss in one month, increasing breathlessness and swelling of both lower legs. The authors reported no asbestos exposure in his history. Heart ultrasound and CT showed fluid around the heart and a large fluid collection in the left chest, but no tumor. Tests of the chest fluid and lung biopsies found no cancer. An infected chest-fluid collection (pleural empyema) was suspected. Fever persisted despite drainage and antibiotics, so the patient had surgery. This found a 13 × 6 cm tumor arising from the pericardium (the sac around the heart) and growing into the heart wall. The tumor was completely removed. The final diagnosis was a predominantly sarcomoid malignant mesothelioma originating from the pericardium, with tumor cells in the pleura as a sign of spread. Chemotherapy was started. The authors concluded that a pleural empyema significantly limits what imaging can show, and that only the operation led to 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 of a single patient, with a brief discussion of published literature
• Who was studied: One 82-year-old male patient seen at the emergency room of Klinikum Frankfurt Höchst, Germany (article published 2019)
• Exposure: The authors reported no asbestos exposure in the patient's history; no fiber type or occupation is described
• Main results:
  • Echocardiography showed the heart function well but did not show the tumor; CT showed a pericardial effusion and a pleural effusion but the tumor could not be diagnosed
  • Cytology of the pleural fluid was negative for malignant cells, and bronchial biopsies of the left lower lobe showed no evidence of malignancy; a pleural empyema was suspected
  • Thoracoscopy showed a grade III pleural empyema
  • Surgery revealed a 13 × 6 cm tumor extending from the pericardium and infiltrating the left ventricle wall; it was completely resected together with an 8 × 8 cm area of pericardium and a 1 × 1 cm superficial area of the left ventricular wall
  • The final pathology examination showed a predominantly sarcomoid malignant mesothelioma originating from the pericardium
  • Tumor cells were found in the pleura, which the authors took as a sign of pleural metastasis
  • Chemotherapy with carboplatin and pemetrexed was begun; the first dose was given six weeks after surgery and was tolerated well
• The authors' conclusion: The authors concluded that, in this case, a pleural empyema significantly limited the diagnostic value of imaging and that the operation led to the diagnosis
• Limitations the authors state:
  • The authors stated that it could not be clarified conclusively whether the tumor promoted the pleural empyema or whether the empyema was a separate condition

Topics

Medical terms in this study, explained in our Lexicon: Pericardial Mesothelioma, Empyema, Dyspnea, Pericardial Effusion, Pleural Effusion.

Related studies

• Surgical pathology of primary cardiac and pericardial tumors — C. Basso, M. Valente, et al. (1997)
• Primary pericardial tumors — C.S. Restrepo, D. Vargas, et al. (2013)
• Primary pericardial mesothelioma: report of two cases and review of the literature — A.L. Sytman, R.N. MacAlpin (1971)
• Primary Pericardial Mesothelioma: Report of a Patient and Literature Review — A. Nilsson, T. Rasmuson (2009)
• Treatment and Outcomes of Primary Pericardial Mesothelioma: A Contemporary Review of 103 Published Cases — E. McGehee, D.E. Gerber, et al. (2019)
• Primary pericardial mesothelioma — N.T. Eren, A.R. Akar (2002)

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