Department of Cardiac Macrovascular Surgery, Affiliated Hospital of Zunyi Medical University, No. 149, Dalian Road, Huichuan District, Zunyi City, 563003, Guizhou Province, China.
BMC Cardiovasc Disord. 2023 Mar 8;23(1):125. doi: 10.1186/s12872-023-03142-w.
Pericardial calcification is usually a marker of chronic diseases, and its occurrence in rapidly progressing malignant primary pericardial mesothelioma (PPM) is extremely rare. Therefore, this atypical imaging appearance contributes to more frequent misdiagnosis of PPM. However, no systematic summary currently exists of the imaging characteristics of malignant pericardial calcification in PPM. In our report, its clinical characteristics are discussed in detail, to provide a reference to reduce the misdiagnosis rates of PPM.
A 50-year-old female patient was admitted to our hospital, presenting primarily with features suggestive of cardiac insufficiency. Chest computed tomography revealed significant pericardial thickening and localized calcification, suspicious of constrictive pericarditis. A chest examination performed through a midline incision showed a chronically inflamed and easily-ruptured pericardium that was closely adherent to the myocardium. Post-operative pathological examination confirmed a diagnosis of primary pericardial mesothelioma. Six weeks postoperatively, the patient experienced symptom recurrence and abandoned chemotherapy and radiation therapy. Nine months postoperatively, the patient died of heart failure.
We report this case to highlight the rare finding of pericardial calcification in patients with primary pericardial mesothelioma. This case illustrated that confirmation of pericardial calcification cannot completely rule out rapidly developing PPM. Therefore, understanding the different radiological features of PPM can help to reduce its rate of early misdiagnosis.
心包钙化通常是慢性疾病的标志物，而在快速进展的恶性原发性心包间皮瘤（PPM）中，心包钙化极为罕见。因此，这种非典型的影像学表现导致了更频繁的 PPM 误诊。然而，目前尚无关于 PPM 中心包钙化的影像学特征的系统总结。在我们的报告中，详细讨论了其临床特征，旨在为降低 PPM 的误诊率提供参考。
一名 50 岁女性患者因主要表现为心功能不全的特征而入院。胸部计算机断层扫描显示明显的心包增厚和局部钙化，疑似缩窄性心包炎。经中线切口进行的胸部检查显示慢性炎症和易破裂的心包与心肌紧密粘连。术后病理检查证实为原发性心包间皮瘤。术后 6 周，患者出现症状复发并放弃化疗和放疗。术后 9 个月，患者死于心力衰竭。
我们报告这个病例是为了强调在原发性心包间皮瘤患者中心包钙化的罕见发现。这个病例表明，心包钙化的确认并不能完全排除快速发展的 PPM。因此，了解 PPM 的不同影像学特征有助于降低其早期误诊率。
