He Cheng-Peng, Tu Di-Wei, Zhang Ting-Wei, Zhang Qian, Zhang Qiang, Kang Di, Wang Ying-Ying, Li Ying-Ying, Zhang Bin, Han Sha-Sha, Li Hong-Bo
Department of Respiratory and Critical Care Medicine Binzhou Medical College Affiliated Hospital (First Clinical Medical College) Binzhou China.
Department of Pathology Binzhou Medical College Affiliated Hospital Binzhou China.
Clin Case Rep. 2023 Jun 20;11(6):e7555. doi: 10.1002/ccr3.7555. eCollection 2023 Jun.
Pleural mesothelioma (PM) with pericardial involvement is extremely rare. We now report a rare case of malignant PM with constrictive pericarditis as the first presentation. A 59-year-old male diagnosed with constrictive pericarditis underwent pericardiectomy and pericardial pathology revealed mesothelial hyperplasia. Eight months after surgery, the patient was admitted to the hospital with chest tightness and wheezing for 5 days. Computed tomography scan of the chest showed a left lung expansion insufficiency, limited bilateral pleural thickening, pericardial thickening with a small amount of pericardial effusion, and multiple enlarged lymph nodes in the mediastinum, bilateral supraclavicular fossa, bilateral cervical roots, and right axilla. The pleural malignancy should be possibly considered. Pathology after pleural puncture showed malignant PM. Pathology after left supraclavicular lymph node puncture biopsy showed metastatic malignant mesothelioma. The diagnosis of this patient was clear. Although malignant PM rarely involves the pericardial constriction, we cannot ignore the fact that malignant PM involves the pericardium. The patient has been diagnosed with constrictive pericarditis, accompanied by pleural thickening and pleural effusion. Without other pathogenic factors, pleural biopsy should be aggressively performed in patients with constrictive pericarditis to determine the cause.
伴有心包受累的胸膜间皮瘤（PM）极为罕见。我们现报告一例罕见的以缩窄性心包炎为首发表现的恶性PM病例。一名诊断为缩窄性心包炎的59岁男性接受了心包切除术，心包病理显示间皮细胞增生。术后8个月，患者因胸闷、气喘5天入院。胸部计算机断层扫描显示左肺扩张不全、双侧胸膜局限性增厚、心包增厚伴少量心包积液，纵隔、双侧锁骨上窝、双侧颈根部及右腋窝多发肿大淋巴结。应考虑胸膜恶性肿瘤的可能。胸膜穿刺术后病理显示为恶性PM。左锁骨上淋巴结穿刺活检术后病理显示为转移性恶性间皮瘤。该患者诊断明确。尽管恶性PM很少累及心包缩窄，但我们不能忽视恶性PM累及心包这一事实。该患者已诊断为缩窄性心包炎，伴有胸膜增厚和胸腔积液。在没有其他致病因素的情况下，对于缩窄性心包炎患者应积极进行胸膜活检以明确病因。
