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A 63-year-old woman with multiple secondary tumours
  1. Ioana Danuta Muresan,
  2. Lucia Agoston-Coldea,
  3. Dan Lucian Dumitrascu
  1. 2nd Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
  1. Correspondence to Dr. Lucia Agoston-Coldea, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; luciacoldea{at}


Clinical introduction A 63-year-old woman recently diagnosed with lung metastasis, after routine chest radiography, was admitted to our hospital for unspecified symptoms, such as dyspnoea on minimal exertion and dry cough. Physical examination showed uncommon signs. The electrocardiogram showed sinus rhythm and incomplete left bundle branch block. Thoracic CT scan revealed bilateral lung and pleural metastases and pelvic CT showed a right femoral bone mass. Transthoracic echocardiography revealed a heterogeneous mass, lateral to the right ventricle, with pericardial effusion. Further, cardiac MRI (cMRI) was performed (figure 1A,B). Diagnosis was completed with an ultrasound-guided biopsy and histopathological examination (figure 1C,D).

Figure 1

(A,B) Cardiac MRI: asterisk is suggestive of fluid and the white arrow indicates fibrous encapsulation by LGE, (C) H&E stain:white arrow indicating a tumoral cell with atypical mitosis and (D) immunohistochemical staining for smooth muscle actin antibody.

Question Which of the following is the most likely diagnosis?

  1. Pericardial lymphoma.

  2. Pericardial leiomyosarcoma.

  3. Pericardial cyst.

  4. Secondary malignant cardiac tumour.

  5. Pericardial teratoma.

  • cardiac magnetic resonance (CMR) imaging
  • pericardial effusion
  • pericardial tamponade
  • palliative care
  • cardiac computer tomographic (CT) imaging

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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.