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PERICARDIAL MESOTHELIOMA
Pericardial Mesothelioma, Pericardial Effusion & Pericardial Masses
Pericardial Mesothelioma
Pericardial Mesothelioma is a tumor that can occur at any age with a
mean age of 46 years at presentation. Patients present with chest pain,
dyspnea, cough, and palpitations. Although there appears to be a strong
link to asbestos exposure, a definite association has not been
established due to the rarity of this lesion. Surgery combined with
radiation therapy may provide some palliation, but the prognosis is
extremely poor. On CT there is irregular, diffuse pericardial thickening
and a pericardial effusion. Pericardium is a thin lining of tissue
surrounding the heart.
Pericardial Effusion
Pericardial effusion is the collection of fluid in the sac that
surrounds the heart, a possible sign of cancer as well as many other
conditions. When it is caused by cancer, it can be result of either
direct spread of cancer from adjacent organs like the lung, or by
metastatic spread from other parts of the body
Pericardial Masses
The most common primary mass is a congenital celomic cyst. Benign and
malignant pericardial solid masses are equally common. Teratoma and
malignant mesothelioma are the leading primary solid masses. Secondary
malignancies are far more common than primary with seventy percent due
to spread from lung, breast and lymphoproliferative disorders. Although
primary tumors more commonly affect the myocardium than the pericardium
the reverse is true of secondary tumors. In those with pericardial
metastases 25% have reduced cardiac function and for the majority
tamponade is the commonest cause of death.
CT features of masses that may elucidate their etiology
include;morphology, location, extent, cyst or solid character, their
effect on cardiac chambers as well as their enhancement characteristics
and the amount of extracardiac disease. It is in the setting of
malignancy with its ability to evaluate the whole thorax that CT has
much to offer.
PERICARDIAL MESOTHELIOMA - CASE STUDY
Primary pericardial mesothelioma:
Yuko Kobayashi1, , Ryusuke Murakami1, Junko Ogura1, Kanae Yamamoto1,
Taro Ichikawa1, Kouichi Nagasawa2, Masaru Hosone3 and Tatsuo Kumazaki4
(1) Department of Radiology, Tama-Nagayama Hospital, Nippon Medical
School, 1-7-1 Nagayama, Tama-shi, Tokyo 206-8512, Japan
(2) Department of Internal Medicine, Tama-Nagayama Hospital, Nippon
Medical School, 1-7-1 Nagayama, Tama-shi, Tokyo 206-8512, Japan
(3) Department of Pathology, Tama-Nagayama Hospital, Nippon Medical
School, 1-7-1 Nagayama, Tama-shi, Tokyo 206-8512, Japan
(4) Department of Radiology, Nippon Medical School, 1-1-5 Sendagi,
Bunkyo-ku, Tokyo 113-8603, Japan
Abstract. The imaging features of primary pericardial mesothelioma have
rarely been described. Herein we present a case report of its
diagnostic-pathologic features. Chest computed tomography (CT) revealed
an irregularly enhanced mass occupying the entire pericardial space and
surrounding the superior vena cava. At autopsy, the tumor was found to
fill the pericardial space completely, and to extend to the superior
vena cava through the superior pericardial sinus. The CT features of the
tumor were correlated well with those revealed at autopsy, and provided
satisfactory information regarding the presence and the extension of the
tumor.
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