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IntroductionIsolated cases of epicarditis are rare. Thus far, all have occurred with constrictive physiology as most cases involve both parietal and visceral pericardium. We report the first case of asymptomatic epicarditis that involved only the visceral pericardium presenting without constrictive physiology.Case presentationA 71-year-old male with a history of atrial fibrillation, coronary artery disease, pericardial effusion, type-2 diabetes and hypothyroidism presented with 5 weeks of fatigue and 1 day of dizziness. Physical examination was significant for pallor and tachycardia. Laboratory analysis revealed a hemoglobin count of 7.2 g/dl and iron deficiency anemia. The patient was transfused and evaluated by endoscopic ultrasound. A polypoid mass in the gastric cardia was found and later diagnosed as gastric adenocarcinoma (staged as T1N0M0). The pericardial effusion was evaluated with transthoracic echocardiography which showed a 2.0 × 2.7 cm mass associated with the right atrium. Transesophageal echocardiography confirmed the mass but did not reveal constrictive physiology. Whole-body contrast computed tomography failed to demonstrate metastatic disease. Biopsy of the cardiac mass revealed epicarditis without parietal pericardium involvement. Partial gastrectomy was performed to remove the gastric adenocarcinoma.ConclusionThis is the first reported case of asymptomatic epicarditis. Our case was especially unusual because the epicarditis presented as an incidental cardiac mass. The clinical picture was complicated due to the concomitant presence of gastric adenocarcinoma and chronic pericardial effusion. This case demonstrates that epicarditis should be considered in the differential diagnosis of cardiac masses.

Epicarditis (visceral pericardial inflammation) is a very unique and rare diagnosis. It is almost always associated with parietal pericardial involvement and may occur in medical conditions such as viral, bacterial (mycobacterial) infections and uremia or postoperatively in the setting of cardiac surgery. Frequently, no etiology is found. Most cases are associated with constrictive physiology, and patients present with symptoms and signs of right-sided heart failure. Effusive epicarditis is often present, and the clinical features may easily be confused with those of pericardial effusion with tamponade. We report a unique case of isolated subacute effusive and nonconstrictive epicarditis mimicking a right atrial mass in a 72-year-old patient who was diagnosed with nonmetastatic gastric adenocarcinoma. Our case is unique for several reasons: inflammation was limited to the epicardium (very few cases have been described to date); the patient was asymptomatic, with no clinical or echocardiographic evidence of constriction (this represents a novel finding, explained in part by the more limited extent of inflammation, with no significant fibrotic component and no parietal pericardial involvement); and this is the first report of epicarditis occurring in association with a malignancy, which we hypothesize may represent an inflammatory paraneoplastic process.