Echocardiographic findings of pericardial involvement in patients with malignant pleural mesothelioma with a history of environmental exposure to asbestos and erionite

Özer, Necla; Shehu, Veprim; Aytemir, Kudret; Övünç, Kenan; Emre, Salih; Kes, Sırrı

doi:10.1111/j.1440-1843.2000.00272.x

Cited by 5 publications

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“…The median survival from the time of diagnosis is less than 6 months 7) . Ozer reported that pleural mesothelioma often invades to the pericardial space in the advanced phase of disease 8) . Therefore, our case must be distinguished from pericardial invasion by pleural mesothelioma.…”

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An Autopsy Case of Primary Pericardial Mesothelioma in Arc Cutter Exposed to Asbestos through Talc Pencils

et al. 2005

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An autopsy case of a primary pericardial mesothelioma in a 53-year-old arc cutter is reported. He had often had the chance to inhale dust generated by sharpening the slate pencils composed of talc. He was admitted for heart failure due to pericardial tumor, but later died. The tumor was mainly located on the pericardium with a thickness of about 2.5 cm. Small nodular disseminations were observed in the left parietal pleura. Microscopically, tumor cells were epitheliallike and rich in histochemical demonstrable hyaluronic acid. Findings of immunohistochemical markers revealed keratin (+), EMA (+), calretinin (+), and CEA (-), which were characteristics of mesothelioma of epithelial type. The number of asbestos bodies (AB) in the lung parenchyma was increased (2,026 AB/gram dry lung tissue). Subsequent transmission electron microscopic examination equipped with an energy dispersive X-ray analyzer revealed that the fibers identified in the lungs were fibrous talc and actinolite. These findings suggested that this patient had been occupationally exposed to asbestos contaminated in the talc pencils, which induced the development of primary pericardial mesothelioma.Key words: Pericardial mesothelioma, Asbestos, Talc pencil, Fiber analysis Primary pericardial mesothelioma is an extremely rare and lethal cardiac tumor 1) . A correlation has been established between exposure to asbestos and the development of pleural and peritoneal mesothelioma in many epidemiological surveys 2) . However, the etiology of pericardial mesothelioma has not been elucidated. We report a case of pericardial mesothelioma occurring in an arc cutter who had used talc pencils, and examined the association between occupational exposure to asbestos and the development of this tumor by mineral analysis.A 53-years-old man was admitted to our hospital because of shortness of breath and leg edema. He had been working for an ironworks for 28 yr. He had used slate pencils composed of talc when he drew the lines of arc cutting on iron plates since he was 26 years-old. He had often inhaled the dust generated when sharpening the talc pencils using sandpaper without respirator. He had smoked 2 packs of cigarettes for 18 yr.Physical examination revealed distended jugular veins and leg edema. Breath sounds were decreased throughout the entire left lung field, but no fine crackle and no heart murmur was audible. His liver edge was palpable five fingerbreadths below the right costal margin.Chest radiography on admission revealed cardiac enlargement and bilateral pleural effusion (Fig. 1a). Computed tomographic scan of the chest revealed bilateral

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An Autopsy Case of Primary Pericardial Mesothelioma in Arc Cutter Exposed to Asbestos through Talc Pencils

et al. 2005

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“…Typically, initial presentation of a thoracic primary mesothelioma comprises anorexia, chest pain and dyspnoea. Progressive disease involving the thoracic cavity results in worsening dyspnoea, chest pain and ultimately death, with a median survival of 1 year following diagnosis 1 4 5…”

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Advanced, recurrent mesothelioma growth mimicking an aortic dissection

Pankhania

Hardiment²,

Marathe³

2011

Case Reports

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In the emergency setting, a cold, clammy, dyspnoeic patient presenting with interscapular chest pain and unequal blood pressures suggests an acute aortic dissection until proven otherwise. By means of a case report, the authors detail one such patient who presented identically to one having an acute aortic dissection. Initial assessment showed unequal blood pressures in left and right arms, a resting tachycardia and indistinct heart sounds. Fluid resuscitation failed to improve the patient's physiological parameters and they rapidly deteriorated. The medical history included mesothelioma and atrial fibrillation. Existing investigations were reviewed and after thorough consideration of the patient's premorbid state and likely prognosis, the decision was made to palliate. The patient died shortly after being transferred to the oncology ward. Imaging is therefore integral to the assessment and management of a patient in whom an aortic dissection is feared.

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Echocardiographic Diagnosis of Malignant Mesothelioma Involving the Pericardium

Shah¹,

Wong²,

Roesch³

et al. 2005

Echocardiography

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A 64-year-old male presented with dyspnea and new-onset atrial fibrillation. His past medical history was remarkable for a fifty packyear history of smoking, asbestos exposure in his youth, and a family history of two uncles diagnosed with mesothelioma. The patient required oxygen of 6L nasal cannula to sustain a saturation of 92% and maintained a heart rate of 100 beats/min on a diltiazem drip. A chest CT showed tumor contiguous with the pericardium (Fig. 1A). Pleural biopsy was performed and pathology showed epitheliod type malignant mesothelioma (Fig. 1B). Transthoracic two-dimensional echocardiography demonstrated a large pericardial effusion (asterisks) with significant pericardial wall thickening (arrows), indicative of tumor extension from the pleura into the pericardium (Fig. 1C, D). Due to worsening dyspnea and the large pericardial effusion, the patient underwent pericardiocentesis with removal of 1000 cc of serosanguinous fluid. The patient's clinical status, however, continued to deteriorate, and the goals of care were altered to comfort care.Although unique cardiac findings have been reported in conjunction with malignant pleural mesothelioma, pericardial involvement occurs frequently. 1,2 It has been noted that approximately 50% of patients with malignant pleural mesothelioma have pericardial involvement based on the echocardiographic findings of pericardial effusion, thickening, calcification, or constriction physiology. 3 Autopsy studies have shown an even greater percentage of cardiac involvement in patients with malignant pleural mesothelioma. 2 Although symptoms of chest pain, dyspnea, and fatigue are generally attributed to pleural disease, echocardiography has been shown to assist in differentiating cardiac manifestations from progressive pulmonary involvement. 2 This case illustrates the echocardiographic findings of pericardial involvement by malignant pleural mesothelioma. Figure 1. (A) Infused chest CT scan depicting abutment of the right-sided pleural mesothelioma with the pericardium. (B) Pleural biopsy demonstrating infiltrative epitheliod type malignant mesothelioma cells. (C) and (D) Short-axis and apical four chamber views demonstrating a large pericardial effusion (asterisk marks) and significant pericardial wall thickening (arrow).

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Echocardiographic findings of pericardial involvement in patients with malignant pleural mesothelioma with a history of environmental exposure to asbestos and erionite

Abstract: Pericardial involvement is commonly seen in patients with malignant mesothelioma. Among patients exposed to asbestos or zeolite there was no difference in terms of pericardial involvement. Furthermore, pericardial involvement was not related with the stage of the tumour.

Cited by 5 publications

References 14 publications

An Autopsy Case of Primary Pericardial Mesothelioma in Arc Cutter Exposed to Asbestos through Talc Pencils

An Autopsy Case of Primary Pericardial Mesothelioma in Arc Cutter Exposed to Asbestos through Talc Pencils

Advanced, recurrent mesothelioma growth mimicking an aortic dissection

Echocardiographic Diagnosis of Malignant Mesothelioma Involving the Pericardium

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