Fatal hemopericardial tamponade due to primary pericardial mesothelioma: a case report

A 45-year-old African American female presented to the emergency department with several days of dizziness, difficulty walking, and low blood pressure. The patient suddenly suffered cardiac arrest, and her death was pronounced. The medical examiner assumed jurisdiction of the case due to the sudden death nature of the case without known medical history. At autopsy, a one-liter hemopericardium was present, and the pericardial sac was thick, granular and adhesed to the heart, suspicious for pericarditis. Microscopic examination of the pericardial tissue instead led to a diagnosis of primary pericardial mesothelioma.Our case demonstrates a pericardial mesothelioma initially masquerading grossly as pericarditis. Microscopic examination of any grossly abnormal pericardial tissue therefore may be warranted so that a neoplastic disease process does not go undetected. Additionally, of the approximately 200 such tumors reported in the medical literature, a case demonstrating marked hemopericardium and resulting in sudden death has not been described until now.Fortunately, mesotheliomas are very uncommon tumors, with an incidence of approximately one per million. Such lesions arising from the pericardium constitute only 0.7% of all cases and therefore represent an extremely rare entity [1]. This neoplasm typically presents insidiously with rather nonspecific signs and symptoms including dyspnea, fever, chest pain, and weight loss. Common clinical manifestations include constrictive pericarditis, pericardial effusion, cardiac tamponade, and eventual heart failure usually stemming from either physical compression or myocardial tumorous infiltration. To date, there are no reported cases in the medical literature describing a pericardial mesothelioma causing marked hemopericardium, and resulting in sudden death. Herein, we report such a case.A 45-year-old African American female presented to the emergency department (ED) with a new onset of dizziness, difficulty walking, and low