A 55-year-old man with a history of pericardiocentesis for massive pericardial effusion of unknown etiology was admitted to our hospital because of shortness of breath and systemic edema in September 2005. Transthoracic echocardiography demonstrated the massive PE 2 cm in diameter and with several areas of thick hyperrefractile echoes arising from the pericardium. Computed tomography (CT) demonstrated a large mediastinal mass encasing the heart; a pressure of the right ventricle (RV) showed a pattern of dips and plateaus on cardiac catheterization. Pericardiocentesis was attempted, but no fluid could be aspirated. The patient's symptoms progressed day by day despite maximum pharmacological support with catecholamines and diuretics. Surgical treatment was planned to relieve the symptoms and confirm the definitive diagnosis. Pericardiectomy and partial resection of the tumor under cardiopulmonary bypass (CPB) could be performed, and this resulted in a marked relief of symptoms. Histological examination confirmed the malignant pericardial mesothelioma. In conclusion, pericardiectomy and resection of the tumor might be indicated for the relief of symptoms in a critical case presenting as pericardial constriction associated with malignant pericardial mesothelioma.
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