Post-Irradiation Malignant Pericardial Mesothelioma with Recurrent Bloody Pericardial Effusion : a Case Report / 日本心臓血管外科学会雑誌

We report a case of a 64-year-old woman with a history of radiation therapy for breast cancer 27 years ago who developed malignant pericardial mesothelioma. Since 3 years ago, the recurrent bloody pericardial effusion was getting worse, which caused general edema and nocturnal dyspnea. She had a thickened pericardium and the right ventricular pressure curve showed a dip-and-plateau pattern. We diagnosed constrictive pericarditis and performed a pericardiectomy and waffle procedure on the thickened epicardium without cardiopulmonary bypass. The post-operative histology confirmed malignant pericardial mesothelioma and she died on the 17th postoperative day. Pericardial malignant mesothelioma is a rare disorder but very aggressive. This fatal disease may be considered in a patient with recurrent bloody pericardial effusion who has a history of thoracic radiation therapy.

A Case of Constrictive Heart Failure Caused by Primary Malignant Pericardial Mesothelioma / 日本心臓血管外科学会雑誌

A 67-year-old man was admitted with right heart failure. He had severe peripheral edema of his lower limbs. The heart failure was treated by diuretics, but after 3 months, he was re-admitted with facial edema and pleural effusion. At this time, the pericardium thickened diffusely and rapidly, constricting the heart. Pericardiectomy was performed to alleviate symptoms of heart failure. The thickened pericardium firmly adhered to the epicardium, from which it was inseparable. A partial pericardiectomy was done. The diagnosis was not confirmed during operation, but primary malignant pericardial mesothelioma was diagnosed on immunohistological examination with carletinin. The patient died from massive pleural effusion and heart failure on the 22nd postoperative day. Primary malignant pericardial mesothelioma is an extremely rare pathology, which is difficult to diagnose and has a poor prognosis. However, this pathology is the disease which we should always mention as a cause of constrictive pericarditis.

Primary Malignant Pericardial Mesothelioma Presenting as Acute Pericarditis

We report on a 21-year-old man with fever, dyspnea, and pleuritic chest pain. An electrocardiography showed ST elevation in multiple lead and thoracic echocardiography revealed moderate pericardial effusion. He was initially diagnosed with acute pericarditis, and treated with nonsteroidal anti-inflammatory drugs and colchicines with clinical and laboratory improvement. After 1 month of medication, his symptoms recurred. An echocardiography showed constrictive physiology and the patient was treated with steroid on the top of current medication. The patient had been well for 7 months until dyspnea and edema developed, when an echocardiography showed marked increased pericardial thickness and constriction. Pericardial biopsy was performed and primary malignant pericardial mesothelioma was diagnosed. Malignancy should be considered in the differential diagnosis of recurrent pericarditis.

Primary Malignant Pericardial Mesothelioma Presenting as Acute Pericarditis

We report on a 21-year-old man with fever, dyspnea, and pleuritic chest pain. An electrocardiography showed ST elevation in multiple lead and thoracic echocardiography revealed moderate pericardial effusion. He was initially diagnosed with acute pericarditis, and treated with nonsteroidal anti-inflammatory drugs and colchicines with clinical and laboratory improvement. After 1 month of medication, his symptoms recurred. An echocardiography showed constrictive physiology and the patient was treated with steroid on the top of current medication. The patient had been well for 7 months until dyspnea and edema developed, when an echocardiography showed marked increased pericardial thickness and constriction. Pericardial biopsy was performed and primary malignant pericardial mesothelioma was diagnosed. Malignancy should be considered in the differential diagnosis of recurrent pericarditis.