J Cardiovasc Ultrasound.  2012 Mar;20(1):57-59. 10.4250/jcu.2012.20.1.57.

Primary Malignant Pericardial Mesothelioma Presenting as Acute Pericarditis

• Choi WS
• Im MS
• Kang JH
• Kim YG
• Hwang IC
• Lee JM
• Lee S
• Shin HS
• Lee SP
• Cho GY

• KMID: 2177343
• DOI: http://doi.org/10.4250/jcu.2012.20.1.57

Abstract

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.

Keyword

Acute pericarditis; Constrictive pericarditis; Primary malignant pericardial mesothelioma

MeSH Terms

Biopsy
Chest Pain
Constriction
Diagnosis, Differential
Dyspnea
Echocardiography
Edema
Electrocardiography
Fever
Humans
Mesothelioma
Pericardial Effusion
Pericarditis
Pericarditis, Constrictive
Young Adult

Figure

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  Fig. 1 Pericardial effusion on initial echocardiographic evaluation.

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  Fig. 2 Moderate amount of pericardial effusion with adhesion after 1 month of treatment with nonsteroidal anti-inflammatory drugs and colchicines.

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  Fig. 3 Improved pericardial effusion with normal pericardial thickness after 4 days of systemic steroid treatment.

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  Fig. 4 Diffuse increased pericardial thickening with pericardial enhancement.

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  Fig. 5 Atypical mesothelial proliferation with papillary growth configuration and nuclear pleomorphism (H&E stain, ×200; scale bar: 40 µm). White arrows: papillary growth configuration.

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