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

Daniel C Lingamfelter1, Dominick Cavuoti, Amy C Gruszecki

  • 1Jackson County Medical Examiners Office, Kansas City, Missouri, USA. DLingamfelter@jacksongov.org

Diagnostic Pathology
|December 17, 2009
PubMed
Abstract

Insights

Primary pericardial mesothelioma is rare and often fatal. This case highlights a rare instance of sudden death caused by this condition, emphasizing the need for microscopic examination of pericardial tissue.

Area of Science:

  • Cardiovascular Pathology
  • Oncology
  • Thoracic Surgery

Background:

  • Primary mesothelioma of the pericardium is an extremely rare malignancy, accounting for less than 1% of all mesothelioma cases.
  • It typically presents insidiously with nonspecific symptoms, often leading to heart failure due to cardiac tamponade or direct tumor constriction.
  • The prognosis is generally poor, with a median survival of approximately six months.

Purpose of the Study:

  • To report a rare case of primary pericardial mesothelioma presenting as sudden cardiac arrest.
  • To emphasize the importance of microscopic examination of pericardial tissue, even when gross findings suggest benign conditions like pericarditis.
  • To highlight a unique presentation of marked hemopericardium leading to sudden death in the context of pericardial mesothelioma.

Main Methods:

  • Case report of a 45-year-old female presenting with sudden cardiac arrest.
  • Autopsy findings included a large hemopericardium and thickened, adherent pericardium.
  • Microscopic examination of pericardial tissue confirmed primary pericardial mesothelioma.

Main Results:

  • The patient experienced sudden cardiac arrest and death.
  • Autopsy revealed a one-liter hemopericardium and pericardial thickening suspicious for pericarditis.
  • Microscopic analysis definitively diagnosed primary pericardial mesothelioma.

Conclusions:

  • Primary pericardial mesothelioma can mimic benign conditions such as pericarditis.
  • Microscopic evaluation of abnormal pericardial tissue is crucial for diagnosing neoplastic processes.
  • This case represents a previously undescribed presentation of pericardial mesothelioma with marked hemopericardium resulting in sudden death.

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