Primary Malignant Pericardial Epithelioid Mesothelioma Presenting as Cardiac Tamponade: A Case Report With
Saubhagya Dhakal1, Paulo Savoia1, Nikahat Yasmine1
1Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA, uihealthcare.org.
Case Reports in Radiology
|July 14, 2026
Summary
Primary pericardial mesothelioma, a rare cancer, can initially mimic complex pericardial effusion. Advanced imaging like cardiac MRI and PET/CT is crucial for diagnosing infiltrative tumors missed by initial scans.
Area of Science:
- Cardiology
- Oncology
- Radiology
Background:
- Primary malignant pericardial mesothelioma is a rare and aggressive cancer.
- It often presents with nonspecific symptoms like pericardial effusion, leading to diagnostic challenges.
- Early diagnosis is difficult as tumors can be occult on initial imaging.
Purpose of the Study:
- To highlight a case of primary malignant pericardial mesothelioma presenting as complex pericardial effusion.
- To emphasize the role of advanced imaging in diagnosing occult pericardial tumors.
- To discuss diagnostic challenges and the importance of further investigation for persistent symptoms.
Main Methods:
- Case report of a 67-year-old woman with chest discomfort and shortness of breath.
- Initial CT pulmonary angiography and thoracic aortic computed tomography angiography (CTA) for acute cardiopulmonary evaluation.
- Subsequent cardiac MRI and FDG PET/CT for detailed characterization and staging.
- Confirmation via thoracoscopy, pericardial biopsy, and immunohistochemistry.
Main Results:
- Initial CTA revealed a large pericardial effusion with tamponade physiology but no discrete mass.
- Cytology from pericardiocentesis was nondiagnostic.
- Cardiac MRI showed an infiltrative pericardial mass; FDG PET/CT confirmed an intensely FDG-avid mass without metastasis.
- Biopsy confirmed epithelioid mesothelioma.
Conclusions:
- Primary malignant pericardial mesothelioma can present initially as complex hemorrhagic pericardial effusion with tamponade.
- Infiltrative tumors may be occult on acute, non-dedicated CTA examinations.
- Persistent symptoms post-drainage warrant advanced imaging (MRI, PET/CT) for diagnosis, staging, and biopsy planning.
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