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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.


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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