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Case reports

Pericardial malignant mesothelioma: a latent complication of radiotherapy?

^a Department of Cardiology, University of Aberdeen, Aberdeen, Scotland AB25 2ZN, United Kingdom
^b Department of Oncology, Aberdeen Royal Infirmary, Aberdeen, Scotland AB25 2ZN, United Kingdom
^c Department of Cardiothoracic Surgery, Aberdeen Royal Infirmary, Aberdeen, Scotland AB25 2ZN, United Kingdom

Received 19 October 2007; received in revised form 28 November 2007; accepted 10 December 2007.

^_* Corresponding author. Tel.: +44 1224 552415; fax: +44 1224 550692. (Email: g.small{at}abdn.ac.uk).

Pericardial diseases can be difficult to differentiate from myocardial conditions. Diagnosis can be challenging and often requires the use of different imaging modalities. Here, we describe a case which presented with common cardiac symptoms which were shown to be the result of a rare condition. A 62-year-old lady presented with left femoral artery embolism. Post-embolectomy she developed cardiac failure. Three months previously an acellular, sterile pericardial effusion had been drained. In 1993 a left mastectomy and axillary node clearance was performed for breast cancer. Adjuvant chemotherapy and radiotherapy were administered. Examination revealed a raised jugular venous pressure (JVP) with rapid Y descent and Kussmaul's sign. CT chest and abdomen found no recurrence of breast carcinoma. Cardiac MRI demonstrated thickened pericardium. At cardiac catheterisation haemodynamic responses consistent with constrictive pericarditis were seen. Pericardiectomy was performed. Histology revealed pericardial epithelioid malignant mesothelioma. 18-FDG-PET CT post-operatively was negative in the pericardium and pleura. Chemotherapy with pemetrexed and carboplatin was given. The patient died 9 months after presentation. Radiotherapy and asbestos exposure are both associated with pericardial mesothelioma and the aetiology in this case was not clear. The condition carries a poor prognosis and is invariable fatal although newer chemotherapeutic regimens have prolonged survival times.

Key Words: Pericardium • Mesothelioma • Radiotherapy