Successful resection of a giant pericardial myolipoma in a resource-limited setting: a case report

Primary pericardial tumors are exceedingly rare. To date, there have been no reports of myolipoma occurring in the pericardial cavity. A dumbbell-shaped myolipoma with intrapericardial extension and a narrow pedicle traversing the pericardial sac is exceptionally rare. Surgical excision of such a large mass is particularly uncommon in resource-limited settings. Here, we report a case of the successful resection of a giant pericardial myolipoma in a 50-year-old female patient managed in a low-resource environment.

A 50-year-old female with a history of hypertension presented with progressive shortness of breath. Laboratory investigations were unremarkable, and cross-sectional imaging revealed a large fat-containing anterior mediastinal mass. The patient underwent surgery through a median sternotomy, which revealed two large lipomatous masses connected by a narrow pedicle traversing the pericardial sac, producing a dumbbell-shaped configuration. Both masses were successfully excised. Histopathology confirmed the diagnosis of myolipoma. The patient had an uneventful recovery and was discharged on postoperative day 14.

Primary pericardial myolipomas are rare, and most patients are asymptomatic. When symptomatic, compressive features predominate. Echocardiography serves as an initial screening tool, but contrast-enhanced cross-sectional imaging remains the cornerstone for diagnosis, surgical planning, and evaluation of tumor extent. Excision of large intrapericardial tumors requires a multidisciplinary approach to achieve optimal outcomes.

This case highlights the rarity of giant pericardial myolipomas and demonstrates that successful surgical excision is feasible, even in resource-limited settings.