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Primary Pericardial Mesothelioma, Which Was Veiled by a Pleural Empyema: A Case Report and Review

Morad Tajjiou1, Wolfgang Wild1, Nasir Sayed1

  • 1Klinik für Allgemein-, Viszeral-, Thorax-und Gefäßchirurgie, Klinikum Frankfurt Höchst, Gotenstraße 6-8, 65929 Frankfurt am Main, Germany.

Case Reports in Surgery
|October 16, 2019
PubMed

Insights

Pleural empyema can obscure imaging results, hindering diagnosis of underlying conditions like pericardial mesothelioma. This case highlights how infections can mask serious diseases, emphasizing the need for surgical exploration when imaging is inconclusive.

Area of Science:

  • Cardiology
  • Thoracic Surgery
  • Oncology

Background:

  • Primary pericardial mesothelioma is a rare malignancy.
  • Diagnostic imaging modalities can be limited by confounding factors.
  • Pleural empyema is a significant thoracic infection.

Observation:

  • An 82-year-old patient presented with symptoms of heart failure, pericardial effusion, and pericarditis.
  • A concurrent pleural empyema masked the underlying pericardial mesothelioma.
  • Echocardiography and CT scans revealed effusions but failed to identify the tumor.

Findings:

  • Pleural empyema significantly limited the diagnostic accuracy of echocardiography and CT.
  • The pericardial mesothelioma was only diagnosed intraoperatively.
  • The case underscores the challenge of diagnosing intrathoracic tumors obscured by infection.

Implications:

  • Clinicians should consider infectious processes as potential confounders in diagnosing cardiac and thoracic malignancies.
  • Surgical intervention may be necessary for definitive diagnosis when imaging is equivocal.
  • This case highlights the limitations of non-invasive imaging in complex thoracic presentations.

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