Chest
Volume 81, Issue 4, April 1982, Pages 520-523
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Selected Reports
Pericardial Mesothelioma

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Pericardial mesothelioma in a 17-year-old boy presented with persistent, febrile pericarditis terminating in acute, fatal cardiac tamponade. Serial echocardiograms suggested pericardial fluid, but at autopsy a diffuse tumor mass was found to be enlarging and obliterating the pericardial space. Computed tomography of the pericardial space was interpreted as demonstrating pericardial thickening. Further investigations by computed tomography using tissue density expressed as attenuation coefficients may prove helpful in distinguishing tumor in the pericardial space from pericardial effusions.

Section snippets

CASE REPORT

Eight weeks prior to admission, this previously healthy, 17-year-old high school boy had sharp, intermittent, nonradiating, substernal chest pain. The pain increased with recumbency, exercise, or deep inspiration, and decreased with rest or erect posture. During this time he lost 6.75 kg and felt weak.

Two weeks before admission he was hospitalized elsewhere for the chest pain and was found to be afebrile but to have a three-component pericardial friction rub. An echocardiogram was interpreted

DISCUSSION

The preceding history of exudative pericarditis followed by pleural effusions and terminated by acute, fatal cardiac tamponade, is similar to previously reported cases of pericardial mesothelioma.3, 4, 5, 6, 7 The presence of microscopic pleural metastases in this case raises questions about the pericardium as the primary site of tumor by the rigid criteria of Anderson and Hansen,5 who restricted primary pericardial mesothelioma to tumor involvement of the pericardium and mediastinal lymph

ACKNOWLEDGMENTS

The authors wish to thank Dr. Daniel Arensberg for clinical assistance, Dr. Howard M. Austin for assistance with computed tomograms, Dr. James L. Clements, Jr, for radiologic interpretations, and Dr. Joel M. Felner for assistance with echocardiographic interpretations.

REFERENCES (9)

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