Shrestha Biraj, Handa Rishin, Poudel Bidhya, Hingorani Rittu
Internal Medicine, Reading Hospital Tower Health, Reading, USA.
Cardiology, Reading Hospital Tower Health, Reading, USA.
Cureus. 2022 Apr 19;14(4):e24270. doi: 10.7759/cureus.24270. eCollection 2022 Apr.
This case report presents a 60-year-old gentleman with a significant smoking history and possible asbestos exposure who was referred to the emergency department for atrial fibrillation with a rapid ventricular rate and symptoms of heart failure. Labs showed normal brain natriuretic peptide and troponin I. His echocardiography finding suggested constrictive pericarditis with an ejection fraction of 60%. A computed tomography scan was concerning for a pericardial mass. Left and right heart catheterization hinted more toward constrictive physiology; however, some findings were concerning for restrictive physiology. Hence, cardiac magnetic resonance imaging was done, which established the diagnosis of constrictive pericarditis. Pericardiectomy was planned with a maze procedure for atrial fibrillation. However, a malignant neoplasm was seen on a frozen biopsy. Hence, surgery was limited to partial pericardiectomy, as the patient had advanced infiltrative neoplasm that had resulted in constrictive pericarditis. The final pathology report confirmed the diagnosis of malignant pericardial mesothelioma mixed type. Malignancy is usually diagnosed in an advanced stage, like in our case, due to nonspecific initial presentation. A literature review suggests that there is a lack of established consensus on treatment. The response to therapy also seems to be poor and results only in palliation of symptoms, with a median survival of six months from diagnosis despite optimum medical management.
本病例报告介绍了一位60岁男性，有大量吸烟史且可能接触过石棉，因快速心室率心房颤动和心力衰竭症状被转诊至急诊科。实验室检查显示脑钠肽和肌钙蛋白I正常。他的超声心动图检查结果提示缩窄性心包炎，射血分数为60%。计算机断层扫描显示心包有肿物。左右心导管检查更倾向于缩窄性生理改变；然而，一些检查结果也提示限制性生理改变。因此，进行了心脏磁共振成像检查，确诊为缩窄性心包炎。计划进行心包切除术并同时行迷宫手术治疗心房颤动。然而，术中冰冻活检发现为恶性肿瘤。因此，由于患者患有晚期浸润性肿瘤导致缩窄性心包炎，手术仅限于部分心包切除术。最终病理报告证实为恶性心包间皮瘤混合型。恶性肿瘤通常在晚期才被诊断出来，就像我们这个病例，因为最初的表现不具有特异性。文献综述表明，对于治疗缺乏既定的共识。治疗反应似乎也很差，只能缓解症状，尽管进行了最佳的药物治疗，从诊断起的中位生存期仍为6个月。
