A recent review of the primary pericardial mesothelioma has been published by Vigneswaran and Stefanacci. It is a rare neoplasm with a reported incidence of 0.0022% in an autopsy series of 5,000,000 case studies 212 and a calculated annual incidence of 1 in 40 million in a Canadian epidemiologic survey. An antemortem diagnosis was made in less than one-third of 150 reported cases in the literature. Pericardial mesotheliomas can occur at any age, but people in the fourth to seventh decades of life are most likely to be afflicted, and there is a 2:1 male to female ratio. Patients generally present with a pericardial effusion, congestive heart failure, an anterior mediastinal mass, or tamponade. Diagnosis can be difficult given the nonspecific presentation, and chest radiography may demonstrate only an enlarged cardiac silhouette. Echocardiography can reveal evidence of an effusion, thickening of the pericardium, or mass involvement of the myocardium. CT scanning or MRI can show a thickened pericardium and may help determine invasion into myocardium.
Currently, surgical excision is the treatment for primary pericardial mesothelioma primarily to palliate symptoms of constriction or tamponade.
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