A 63-year-old female presented to pulmonary medicine OPD with complaints of breathlessness and cough for two weeks and intermittent fever for one week. She had pain in the left side of her chest for six months. She was a known case of diabetes mellitus but was not on any treatment. On admission, her blood pressure was 130/90 mmHg, pulse rate of 96/min, respiratory rate of 18/ min and her SpO 2 was 98% at room air. On examination, her heart sounds were normal (no murmurs heard), respiratory system examination revealed bilateral normal vesicular breath sounds with bilateral wheeze, central nervous system and per abdomen examination were unremarkable. A 2D ECHO done revealed a normal study with ejection fraction of 60%. Pulmonary function test showed a restrictive lung disease. Upon chest x-ray she was found to have a homogenous opacity in her left lung lower zone and CT scan revealed a pericardial mass in the posterior aspect with non-homogenous and irregular contrast enhancement in axial and coronal images, along with minimal pleural effusion [Table/ Fig-1]. Decision for surgical removal of the mass was taken due to clinical symptom of breathlessness which could have been produced due to pressure effect on the lung due to the pericardial mass.She underwent anterolateral thoracotomy and excision of the mass was done which was arising from the pericardium, in the posterior aspect. There was no extension of the mass into any cardiac chamber. The mass was sent for histopathological examination and gross examination revealed a soft cystic mass weighing 100 gm and measuring 7 x 6.5 x 5 cm. Outer surface appeared smooth and had a fibrous covering. Cut surface was hemorrhagic with oozing of blood and had spongy, cyanotic appearance. Spongy spaces were filled with blood. Central portion showed grey white areas [Table/ Fig-2].Microscopic examination showed a lesion covered by thick fibrocollagenous covering with focal flattened mesothelial lining on the surface. The lesion was composed of numerous irregular, cavernous spaces set in a loose fibrous stroma. Cavernous spaces had thin walls lined by single layered endothelium, few vessels showed smooth muscles [Table/ Fig-3]. Most of the spaces were filled with blood, while occasional spaces showed fresh thrombi. Stroma showed focal myxoid change. The patient eventually died due to co-morbidities in the postoperational period.
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