Pericardial mesothelioma presenting as a suspected ST-elevation myocardial infarction

Abstract

Primary cardiac and pericardial tumors are rare entities with an autopsy frequency of 0.001-0.03%. Metastases to the heart and pericardium are much more common than primary tumors. Malignant pericardial mesotheliomas account for up to 50% of primary pericardial tumors. We report the case of a 75-year-old woman with hypertension, dyslipidemia and atrial fibrillation who went to the emergency department due to nonspecific thoracic discomfort of over six hours duration associated with syncope. Physical examination revealed a low-amplitude arrhythmic pulse, no heart murmurs and no signs of pulmonary congestion. The ECG revealed atrial fibrillation with ST-segment elevation in V2-V6, I and aVL. The patient was transferred for emergent coronary angiography, which revealed a long stenosis in the mid-distal portion of the left anterior descending artery. The echocardiogram showed a large pericardial effusion with diffuse thickening of the myocardium. Due to worsening hemodynamics, cardiac rupture was suspected and the patient underwent urgent sternotomy and pericardiotomy with drainage of a large quantity of hematic fluid. The surgeons then identified a large, unresectable tumor occupying the distal half of the anterior portion of the heart. This is, to our knowledge, the first case report of primary pericardial mesothelioma presenting with suspected ST-elevation myocardial infarction. In this case, direct observation of the tumor led to biopsy and the final diagnosis. These are highly malignant tumors and when diagnosed are usually already at an advanced stage.

Co-existing pericardial and pleural malignant mesothelioma responding well to nedaplatin and pemetrexed: a case report

“…Its common images show pleural effusion, diffuse pleural thickening, pulmonary nodules, lung encasement, mediastinal shift and elevation of hemidiaphragm ( 11 ). Primary pericardial MM is extremely infrequent tumor with the prevalence of 0.001–0.007% among cardiac tumors ( 12 ). Metastases to heart and pericardium are much more frequent than primary malignancy ( 13 ).…”

Malignant mesothelioma associated with localized myocardial fibrosis: a case report

“…We searched medical databases for keywords “mesothelioma left ventricular dysfunction”/scarring”/aneurysm”, “mesothelioma heart failure”, and reviewed available case reports. To our knowledge, a case of malignant mesothelioma causing localized LV dysfunction has not yet been described apart from cases in which malignant mesothelioma invaded the myocardium [ 3 ]. Since an invasion of the tumor into the myocardium was not detected in our patient, we attributed formation of a myocardial scar to proximity of malignant mesothelioma with the myocardium.…”

Imaging of Malignant Pleural, Pericardial, and Peritoneal Mesothelioma

“…Focal pericardial uptake can aid in the diagnosis of malignant versus benign pericardial thickening; localization for biopsy; evaluation of the presence, location, and extent of local tumor involvement; and distant metastasis. 40,54 The utility of FDG PET/CT is highlighted by the fact that ~50% of cases are found to have metastasis in the local mediastinal lymph nodes and lungs. 55…”