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Heart, Lung and Circulation

A Rather Unusual Cause of Dyspnoea – Pericardial Malignancy

Published:October 20, 2022DOI:https://doi.org/10.1016/j.hlc.2022.09.008
      A 74-year-old female presented to the emergency department (ED) in Canberra Hospital on a Saturday evening with 10 days of exertional dyspnoea. Her medical history was unremarkable except for treated hypertension and obesity. Her vital signs were all within normal limits. She underwent a computed tomography (CT) pulmonary angiogram in ED which ruled out pulmonary embolism but revealed a pericardial effusion measuring approximately 25 mm and as such was referred to cardiology for consideration of urgent pericardiocentesis. A prompt transthoracic echocardiogram carried out late Saturday night, demonstrated a moderate-sized pericardial effusion but more importantly, only in subcostal views, revealed a large spherical pericardial mass measuring 55 x 51 mm (Figure 1, Panel A) adjacent to the right ventricle. However, no such mass was reported in the CT report. In the absence of clinical or echocardiographic features of tamponade and due to the presence of a potential tumour, pericardiocentesis was not attempted. Cardiothoracic surgeons were notified in the event of an acute deterioration.
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      Figure 1Multimodality imaging confirming the presence of multiple pericardial tumours. Panel A: Subcostal echocardiography view reveals a spherical mass (5.5 x 5.1 cm) compressing right atria and ventricle. Panel B: An axial, soft tissue window CT image confirms a large mass in the pericardium adjacent to the right atrium and right ventricle (white arrow). Panel C: A coronal, soft tissue window CT image shows multiple masses in the pericardium (white arrows). Panel D: A fluorodeoxyglucose-PET image showing three tracer hot spots in the pericardium. Panel E: A coronal, fused PET-CT image showing intense uptake in two masses–the largest pericardial mass is in the midline adjacent to the right ventricle.
      Abbreviations: CT, computed tomography; PET, positron emission tomography.

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