Pericardial mesothelioma. Apropos of a case

A 74 year old woman without previous cardiovascular disease presented with pericardial effusion and tamponade. Two-dimensional echocardiography displayed a pericardial mass, but a diagnosis of tumour was not envisaged. Pericardiocentesis produced an exudative fluid with lymphocytes but no malignant cells. Pericardial biopsies through axillary thoracotomy indicated chronic progressive pericarditis. As the patient's haemodynamics deteriorated, sternotomy was carried out showing diffuse pericardial sclerosis corresponding, at histology, to a mixed, predominantly fibroblastic pericardial mesothelioma. The authors describe the main clinical characteristics of pericardial mesothelioma, always discovered belatedly at surgery or necropsy. They insist on the value of non-invasive methods (two-dimensional echocardiography, computed tomography) to diagnose a pericardial tumour, and on the poor prognosis of mesotheliomas, treatment still being uncertain due to the small number of cases and to the early occurrence of cardiac complications.