Pericardial mesothelioma presenting as chronic constrictive pericarditis. A series of three cases from a single institution

Pericardial mesotheliomas are rare tumors which often present with features of constrictive pericarditis. We present clinical, imaging, histological, and immunohistochemical findings of three cases presenting with chronic constrictive pericarditis. Two of these cases were initially treated as tuberculous pericarditis. Histologically, all the three cases were of an epithelioid type and showed positivity for more than one mesothelial markers. Two patients had a fatal outcome, and one was lost to follow-up.

Revisión y experiencia en cinco casos de pericardiectomía extensa / Review and experience in five cases of extensive pericardiectomy

Objetivo: describir evolución de casos tratados por pericarditis constrictiva. Métodos: se presentan 5 casos tratados por orden cronológico por pericarditis constrictiva en los hospitales Amalia Simoni de Camagüey (4) y Martín Chang Puga de Nuevitas (1), en 5 años (2004-2008), cuya indicación quirúrgica principal fue la evidencia clínica de taponamiento cardiaco. Resultados: la edad promedio fue 49 años (rango 36-68), 4 pacientes del sexo masculino, en 4 el derrame fue serohemático y otro purulento. En un paciente apareció el corazón en coraza con calcificaciones. La etiología fue postraumática, infección aguda y metástasis pericárdica en un caso cada una. En 2 pacientes no se confirmó la tuberculosis pericárdica extrapulmonar, aunque pudo corresponderse. El acceso al tórax mayormente fue por toracotomía anterior izquierda, y el proceder fue la pericardiectomía extensa, previa punción pericárdica. De los 5 casos, 3 pacientes egresaron vivos y 2 fallecidos. Conclusiones: los pacientes con pericarditis constrictiva, derrame y signos de taponamiento cardiaco deben ser tratados con pericardiocentesis, y la pericardiectomía extensa, cuando esté indicada. Se considera una buena opción terapéutica(AU)

Objective: to describe the evolution of the cases treated by constrictive pericarditis. Methods: a retrospective study was performed in five cases treated by chronological order due to constrictive pericarditis in the hospitals Amalia Simoni of Camagüey province (4) and "Martin Chang Puga" of Nuevitas municipality (1) in 5 years (2004-2008) whose main surgical indication was the clinical evidence of cardiac tamponage. Results: mean age was of 49 years (range 36-68), four male patients in four of the leakage was serohematinic and another purulent type. In a patient there was a barrier heart with calcifications. Etiology was post-traumatic, acute infection and pericardial metastasis in a case each. In two patients extrapulmonary pericardial tuberculosis was not confirmed, although it could correspond. The thorax approach was mainly by left anterior thoracotomy and the procedure was an extensive pericardiectomy, previous pericardial puncture. From 5 cases, three patients were discharged alive and two dyed. Conclusions: patients presenting with constrictive pericarditis, leakage and signs of cardiac tamponage must to be treated with pericardiocentesis and the extensive pericardiectomy, when be prescribed. This is a good therapeutic option(AU)