ANGIOCARDIOGRAPHY IN MESOTHELIOMA OF THE PERICARDIUM

Angiocardiography in a patient with pericardial effusion and venous hypertension established the effusive-restrictive feature of the pericarditis. A filling defect in the left subclavian vein indicated thrombosis. Later, when the patient failed to respond to therapy with anticoagulants and began having signs of superior vena cava occlusion, angiocardiography showed extension of the thrombus into the superior vena cava and upper portion of the right atrium, but with subsidence of the pericardial effusion.

The final diagnosis of pericardial mesothelioma was made on postmortem examination. Failure to explore the mediastinum because of the poor condition of the patient, and the absence of tumor in the pericardium prevented establishing the diagnosis before death.

Although usually fatal, the report in the literature of 1 case surviving over 5 years and another case 1 year after excision of most of the tumor and radiation therapy emphasizes that early diagnosis is important. For this reason, angiocardiography is recommended. If diagnosis is still uncertain, exploratory pericardial and mediastinal surgery is recommended. In this way, a highly malignant disease may be slowed and perhaps cured.

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