A case of primary malignant pericardial mesothelioma.

Primary malignant pericardial mesothelioma (PMPM) is an exceedingly rare tumour. One of the largest necropsy series gave an incidence of primary pericardial tumours of 0.0022%, of which mesothelioma is the most common type. In a Canadian epidemiological survey, the annual incidence of PMPM was reported to be one in 40 million. A male predominance of the disease has been described, and the majority of cases occur in the fourth to seventh decades of life. There has been no definite association between asbestos exposure and pericardial disease. Due to its generally late presentation and poor response to therapy, the prognosis is very poor. The present report discusses the case of a 43-year-old man who presented with cardiac tamponade and was subsequently diagnosed with PMPM. Cardiac tamponade is a known complication of the malignancy, but it is rarely the first manifestation of cancer. The patient's clinical course was a result of the aggressive nature of PMPM. Effusive constrictive pericarditis and restrictive cardiomyopathy were likely contributors to this patient's disease burden. These processes should be considered and managed appropriately in patients who do not respond to pericardiocentesis or pericardial window as treatment for pericardial tamponade.