What is Pericardial Mesothelioma?
The pericardium is a thin lining of tissue surrounding the heart. Pericardial mesothelioma is a tumor that can occur at any age with a mean age of 46 years at presentation. Patients with pericardial mesothelioma typically have chest pain, dyspnea, cough, and palpitations. Although there appears to be a strong link to asbestos exposure, a definite association has not been established due to the rarity of this lesion. Surgery combined with radiation therapy may provide some palliation, but the prognosis is extremely poor. On CT’s there is irregular, diffuse pericardial thickening and a pericardial effusion.
Pericardial Effusion
Pericardial effusion is the collection of fluid in the sac that surrounds the heart, a possible sign of cancer as well as many other conditions. When it is caused by cancer, it can be the result of either direct spread of cancer from adjacent organs like the lung, or by metastatic spread from other parts of the body.
Pericardial Masses
The most common primary mass is a congenital celomic cyst. Benign and malignant pericardial solid masses are equally common. Teratoma and malignant mesothelioma are the leading primary solid masses. Secondary malignancies are far more common than primary with seventy percent due to spread from lung, breast and lymphoproliferative disorders. Although primary tumors more commonly affect the myocardium than the pericardium, the reverse is true of secondary tumors. In those with pericardial metastases 25% have reduced cardiac function and for the majority tamponade is the most common cause of death.
CT features of masses that may elucidate their etiology include: morphology, location, extent, cyst or solid character, their effect on cardiac chambers as well as their enhancement characteristics and the amount of extracardiac disease. It is in the setting of malignancy with its ability to evaluate the whole thorax that CT has much to offer.
