Key result
Atypical flocculent pericardial effusion can herald primary pericardial mesothelioma, warranting prompt advanced diagnostic evaluation.
Why the study?
Primary pericardial mesothelioma is a rare cardiac neoplasm with non-specific symptoms and lacks effective routine diagnostic methods, leading to frequent misdiagnosis and delayed treatment.
Case Report (n=1)
No
Recurrent unexplained pericardial effusion accompanied by atypical echocardiographic features such as flocculent echoes and irregular thickening should raise suspicion for primary pericardial mesothelioma to avoid diagnostic delays.
May prompt earlier biopsy consideration in atypical recurrent pericardial effusion; extends sparse case literature but should not yet change practice.
Background Primary pericardial mesothelioma (PPM) is an exceedingly rare, highly invasive cardiac neoplasm with insidious onset and non-specific clinical symptoms. Due to the lack of typical early manifestations and effective routine diagnostic methods, PPM is often misdiagnosed and missed, resulting in delayed treatment and poor prognosis. Case presentation A 42-year-old male presented with 6 months of recurrent chest tightness and pain, worsening over 2 months, and two prior admissions for unexplained pericardial effusion. On admission, he had tachycardia, distant heart sounds, bilateral lower extremity edema, and a 3×2 cm hard, fixed left supraclavicular lymph node. Imaging confirmed pericardial effusion with abnormal pericardial lesions. Ultrasound-guided pericardiocentesis yielded only a small amount of red jelly-like material, with cytology suggesting epithelioid neoplastic cells. Supraclavicular lymph node biopsy confirmed metastatic malignant mesothelioma. Nivolumab immunotherapy showed no improvement. Pericardial tumor resection revealed diffuse, fish-flesh-like tumor invading the myocardium and great vessels. Final pathology confirmed epithelioid-type PPM. Conclusion Patients with recurrent unexplained pericardial effusion and atypical sonographic features, such as flocculent echoes and irregular pericardial thickening, should raise suspicion for PPM. Early recognition of these signs and timely pathological confirmation are critical to avoid diagnostic delays and may improve outcomes.
No takes yet. Share an insight, caveat, or question.
Zhu et al. (2026) conducted a case report in Primary pericardial mesothelioma (n=1). Nivolumab and palliative surgical resection was evaluated. Primary pericardial mesothelioma can masquerade as recurrent pericardial effusion, necessitating early suspicion when atypical sonographic features such as flocculent echoes are present.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: