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• W2602445673 abstract "Primary cardiac and pericardial tumors are rare entities with an autopsy frequency of 0.001-0.03%. Metastases to the heart and pericardium are much more common than primary tumors. Malignant pericardial mesotheliomas account for up to 50% of primary pericardial tumors. We report the case of a 75-year-old woman with hypertension, dyslipidemia and atrial fibrillation who went to the emergency department due to nonspecific thoracic discomfort of over six hours duration associated with syncope. Physical examination revealed a low-amplitude arrhythmic pulse, no heart murmurs and no signs of pulmonary congestion. The ECG revealed atrial fibrillation with ST-segment elevation in V2-V6, I and aVL. The patient was transferred for emergent coronary angiography, which revealed a long stenosis in the mid-distal portion of the left anterior descending artery. The echocardiogram showed a large pericardial effusion with diffuse thickening of the myocardium. Due to worsening hemodynamics, cardiac rupture was suspected and the patient underwent urgent sternotomy and pericardiotomy with drainage of a large quantity of hematic fluid. The surgeons then identified a large, unresectable tumor occupying the distal half of the anterior portion of the heart. This is, to our knowledge, the first case report of primary pericardial mesothelioma presenting with suspected ST-elevation myocardial infarction. In this case, direct observation of the tumor led to biopsy and the final diagnosis. These are highly malignant tumors and when diagnosed are usually already at an advanced stage. Os tumores primários do coração e pericárdio são entidades raras, com uma frequência estimada em autópsias de 0,001-0,03%. A metastização do coração e pericárdio é muito mais comum do que os tumores primários. O mesotelioma maligno do pericárdio pode atingir 50% dos casos de tumores primários do pericárdio. Mulher de 75 anos, com hipertensão arterial, dislipidemia e fibrilhação auricular. Recorreu ao serviço de urgência por desconforto torácico inespecífico, com mais de seis horas de duração, associado a síncope. No exame objetivo foi detetado pulso arrítmico de baixa amplitude, ausência de sons cardíacos, sem sinais de congestão pulmonar. O ECG mostrou fibrilhação auricular e elevação do segmento ST em V2-V6, I e aVL. A doente foi transferida para angiografia coronária urgente, que mostrou estenose na porção médio-distal da artéria descendente anterior esquerda. O ecocardiograma revelou derrame pericárdico de grande volume com espessamento difuso do miocárdio. Devido a agravamento hemodinâmico, houve suspeita de rutura cardíaca e a doente foi submetida a esternotomia e pericardiotomia emergentes, com drenagem de grande quantidade de líquido hemático. Foi observada existência de volumoso tumor irressecável, ocupando a metade distal da face anterior do coração. O nosso caso é o primeiro, de que temos conhecimento, que descreve um caso de mesotelioma do pericárdio primário que se apresenta como suspeita inicial de enfarte do miocárdio com supra-ST. Neste caso, a observação direta do tumor permitiu a realização de biopsia e o diagnóstico final. Estes tumores são altamente malignos e, quando diagnosticados, estão habitualmente num estádio avançado." @default.
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• W2602445673 date "2017-04-01" @default.
• W2602445673 modified "2023-10-02" @default.
• W2602445673 title "Pericardial mesothelioma presenting as a suspected ST-elevation myocardial infarction" @default.
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• W2602445673 doi "https://doi.org/10.1016/j.repc.2016.03.014" @default.
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