Primary pericardial mesothelioma is a rare, aggressive malignancy that can present with features of pericardial constriction and has a poor prognosis.
May mimic constriction with poor post-pericardiectomy survival; leaves open earlier noninvasive diagnosis in atypical cases.
A 19 year old man presented with a six month history of chest pain, dyspnoea, and lethargy and was found on an echocardiogram to have a dilated left ventricle with a small pericardial effusion. Ramipril and a course of steroids were tried but serial echocardiograms showed a persistently thickened pericardium and slowly developing features of constriction. On computed tomography, a large mediastinal mass encasing the heart, along with para-aortic and paratracheal lymphadenopathy, was found. Right heart catheter studies showed equal pressures in all four chambers. His deteriorating clinical condition led to a pericardiectomy. Histology confirmed primary pericardial mesothelioma. The patient died soon after surgery.
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Соман Омана Суман (2003) studied this question.
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