Wide complex ventricular tachycardia presenting sign of metastatic pleural mesothelioma

Malignant mesothelioma is an uncommon neoplasm of serosal surfaces, such as the pleura, the peritoneum, less frequently pericardium and tunica vaginalis. It usually spreads locally to the lungs and mediastinum. We describe a case of malignant mesothelioma with metastasis to the heart. The patient presented with syncope, chest pain and light-headedness. He was found to have wide complex ventricular tachycardia (Vtach). He was cardioverted and then noted to have multiple (more than 20) similar episodes during the hospital course. He was treated with multiple antiarrhythmic medications. A CT scan of the chest revealed a circumferential rind of soft tissue in the right hemithorax and invasion of the pericardium. The repeated Vtach episodes were secondary to the metastasis of the pericardium. Oncology was involved and as there were no further treatment options available, the patient was discharged home with hospice care. The disease is a huge economic burden and early recognition can lead to better outcomes.