# A peculiar presentation of tamponade: pericardial mesothelioma

## TL;DR

This paper presents a rare case of pericardial mesothelioma, a rare heart tumor often misdiagnosed and with limited treatment guidelines.

## Contribution

The paper contributes a new clinical case of pericardial mesothelioma and highlights the challenges in its diagnosis and management.

## Key findings

- Pericardial mesothelioma is rare and often misdiagnosed, with only 25% of cases identified before death.
- There is no standardized management algorithm for pericardial mesothelioma due to its rare and variable presentation.
- The average life expectancy after diagnosis is only 3–10 months.

## Abstract

Pericardial mesothelioma (PM) is rare with only 200 cases recorded, and a post-mortem prevalence of <0.0022%. It is the third most common cardiac/pericardial tumour, behind angiosarcoma and rhabdomyosarcoma. PM incidence increases with age, typically incidentally diagnosed between 50 and 70 years, with a 3:1 male predominance. Occasional PM can cause chest pain, dyspnoea, cough and even dysphagia. PMs are often misdiagnosed with only 25% of cases being antemortem diagnoses. Unlike pleural mesothelioma, the link between asbestos exposure and malignancy is less convincing, with only 20% of cases having known exposure. 6 There are three histological types: epithelioid, fibrous (spindle cell), and biphasic (mixed). The average life-expectancy post diagnosis is 3–10 months. Due to the heterogeneity of the presentation and rarity there is no standardized management algorithm, and the diagnostic imaging or laboratory investigations are scarcely described. We are presenting one of the cases diagnosed in our unit here in the Gold Coast.