Pericardial Mesothelioma

Pericardial mesothelioma is a rare malignant neoplasm arising from the mesothelial cells of the pericardium. Prior asbestos exposure has a strong reported association. The tumor may thicken the pericardium and stimulate fluid accumulation, sometimes producing a hemorrhagic effusion. The pericardium normally contains a small amount of lubricating fluid. Malignant fluid or tumor tissue increases pressure around the heart. During diastole, the atria and ventricles cannot expand normally, so venous return backs up while ventricular filling and stroke volume decline. A rapidly accumulating effusion can cause cardiac tamponade; slower tumor-related thickening can create constrictive physiology. Both mechanisms can produce dyspnea, chest discomfort, fatigue, jugular venous distention, edema, and other congestive heart-failure symptoms. The tumor label matters less at the bedside than the hemodynamic effect. A patient can deteriorate from impaired cardiac filling before the malignancy has been confirmed.