Fatal hemopericardial tamponade due to primary pericardial mesothelioma: a case report

Abstract

BackgroundPrimary mesothelioma of the pericardium comprises less than 1% of all mesothelioma cases. Its typical presentation is insidious, with nonspecific signs and symptoms, and usually results in heart failure due to cardiac tamponade, either by a serous effusion or by direct tumorous constriction of the heart. With the exception of several case reports, the outcome is uniformly fatal, and patients typically die within six months of diagnosis.Case presentationA 45-year-old African American female presented to the emergency department with several days of dizziness, difficulty walking, and low blood pressure. The patient suddenly suffered cardiac arrest, and her death was pronounced. The medical examiner assumed jurisdiction of the case due to the sudden death nature of the case without known medical history. At autopsy, a one-liter hemopericardium was present, and the pericardial sac was thick, granular and adhesed to the heart, suspicious for pericarditis. Microscopic examination of the pericardial tissue instead led to a diagnosis of primary pericardial mesothelioma.ConclusionOur case demonstrates a pericardial mesothelioma initially masquerading grossly as pericarditis. Microscopic examination of any grossly abnormal pericardial tissue therefore may be warranted so that a neoplastic disease process does not go undetected. Additionally, of the approximately 200 such tumors reported in the medical literature, a case demonstrating marked hemopericardium and resulting in sudden death has not been described until now.

Sudden cardiac death due to primary malignant pericardial mesothelioma: Brief report and literature review

“…In PMPM cases associated with CT, only 37 cases have been reported. Of these published cases, only three other patients also resulted in SCD [7,11,12]. A brief comparison between these published cases and ours is showed in Table 1.…”

“…SCD due to CT in the context of primary malignant mesothelioma of the pericardium (PMPM) is a very uncommon condition [7,8]. Not surprisingly, the cyto-histologic findings in such cases have not been well elucidated.…”

A Case Report of Primary Pericardial Malignant Mesothelioma Treated with Pemetrexed and Cisplatin

“… Kaplan-Meier curve of overall survival of 24 patients with pericardial malignant mesothelioma ( 1 2 3 4 6 7 8 9 11 12 13 14 15 16 17 18 19 20 ). …”

Unusual Presentation of a Primary Pericardial Malignant Mesothelioma: Constrictive Pericarditis A Case Report and Review of the Literature

“…It seems to have a complex pathogenicity combining environmental carcinogens (asbestos), radiations, virus and genetic factors [4]. Asbestos exposure is observed seldom in primitive pericardial localizations but it occurs if a pleural disease is coexisting [5]. During the last decade, the alleged role of SV40 virus has become predominant in the genesis of mesothelioma [6].…”

“…The mesothelioma appears in ultrasound as a pericardial mass infiltrating the large vessels of the heart. It is rarely revealed by a pericardial effusion of great abundance causing a tamponade [5].…”