Malignant pleural mesothelioma, representing approximately 0.17% of cancer cases, was identified as the elusive cause of recurrent pericardial effusions in a 50-year-old male.
Case Report (n=1)
Malignant pleural mesothelioma is a rare but critical differential diagnosis for recurrent pericardial effusions, particularly in patients from regions with overlapping exposure risks such as asbestos and tuberculosis.
Abstract Introduction Malignant pleural mesothelioma is a rare cancer, representing approximately 0.17% of all estimated cancer cases in 2020, and is associated with asbestos exposure. Even more uncommon is the development of a pericardial effusion secondary to this mesothelioma. Only a small number of case reports have documented this presentation. Case A 50-year-old male from the Congo with a history of recurrent pericardial effusions (status post two pericardial windows), superior vena cava (SVC) and brachiocephalic vein thrombosis, and deep vein thrombosis presented weeks after a pericardial window with fever, neck swelling, cough, and dyspnea. On admission, he was afebrile, tachycardic to 110s, and saturating 95% on 5L oxygen, with labs notable for hemoglobin 11.9, WBC 13.4, CRP 102, negative troponins, and TSH 2.9. CT imaging demonstrated persistent SVC and brachiocephalic vein thrombosis, ground-glass opacities, and mediastinal lymphadenopathy; however, a previous biopsy ruled out malignancy. SVC syndrome was managed with thrombectomy and anticoagulation. A positive QuantiFERON-TB Gold test prompted empiric treatment, but further MTB PCR and BAL acid-fast stains were negative. A right axillary lymph node biopsy ultimately revealed malignant pleural mesothelioma. The patient was discharged with oncology follow-up and isoniazid for latent TB, but was readmitted twice the following month for pleural effusions and chest pain, requiring thoracentesis, PleurX catheter placement, and talc pleurodesis. On final admission, a new pericardial effusion prompted repeat pericardial window, revealing a large hemorrhagic effusion and right atrial perforation due to mass invasion. Multiple nodules encased the SVC and invaded the right atrium. The lesion was deemed non-repairable, and the patient expired intraoperatively. Discussion Malignant pleural mesothelioma rarely involves the pericardium, and recurrent pericarditis is even less common; primary pericardial mesothelioma is more often associated with pericardial disease. In this case, diagnosis was delayed due to conflicting TB testing, negative mediastinal biopsy, and the patient’s origin from the Congo, where both asbestos and tuberculosis are prevalent. Tuberculosis was initially suspected, but the presentation was ultimately attributed to malignancy. Recurrent pericarditis was likely driven by mediastinal lymphadenopathy and invasion of the right atrium, causing pericardial infiltration and impaired lymphatic drainage. Conclusion Pericardial effusion secondary to malignant pleural mesothelioma is rare, with only a few case reports documented. In patients from regions with overlapping exposure risks, specifically asbestos and endemic tuberculosis in this case, malignant mesothelioma should be considered in the differential diagnosis of recurrent pericarditis, particularly when standard workup and therapies fail to resolve the condition. This abstract is funded by: None
Patil et al. (2026) conducted a case report in Malignant pleural mesothelioma (n=1). Malignant pleural mesothelioma, representing approximately 0.17% of cancer cases, was identified as the elusive cause of recurrent pericardial effusions in a 50-year-old male.