Giant pericardial mass case report: role of echocardiography

Cardiac masses are rare and they are distinguished in tumors and non-tumoral masses. Primary pericardial masses are very rare and they are often asymptomatic, even if they can present with sudden cardiac death. The diagnosis of these masses is often accidental and they are generally identified with echocardiography; their characterization is usually performed by cardiac magnetic resonance imaging (MRI) but the definitive diagnosis is achieved by tissue biopsy. We described a case of primary pericardial mass in an old patient with history of hypertension, which presented at our hospital with dyspnea and low-extremity edema. The echocardiography described a giant iso/hypoechoic pericardial mass that extended on anterior, posterior and lateral walls of left ventricle and atrium, associated with pericardial effusion without hemodynamic compromise. We discovered that the mass was identified twenty years ago on a chest-computed tomography (CT). Even if we do not manage in performing a cardiac MRI, from echo characteristics we supposed that the mass was a lipoma. Lipomas are benign tumors that can develop from pericardium and they have slow growth so they can be asymptomatic for several years. Their excision is important because they may be responsible for pericardial tamponade or heart failure. Echocardiography is an economic non-invasive exam and it is helpful in differential diagnosis, treatment, follow-up and prognosis of this cardiac masses.