Pericardial Mass
Gregory Kicska, MD, PhD
DIFFERENTIAL DIAGNOSIS
Common
Metastatic Disease
Loculated Fluid or Focal Thickening
Less Common
Benign Primary Pericardial Tumors
Rare but Important
Primary Pericardial Mesothelioma
Other Malignant Primary Pericardial Tumors
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
Diagnostic evaluation should focus on distinction between neoplastic and nonneoplastic etiology
Loculated fluid or thickening can easily be confused with neoplastic pericardial mass
If patient has history of breast cancer, lung cancer, or lymphoma cancer, focal thickening is equally likely to be metastatic tumor versus other cause
Without history of cancer, undiagnosed malignancy should be considered less likely
Absence of enhancement or low-density fluid suggest nonneoplastic etiology
Helpful Clues for Common Diagnoses
Metastatic Disease
Far more common than primary tumors
Nodular, enhancing pericardium; mediastinal adenopathy
Lung, breast, and lymphoma account for 75% of cases
Loculated Fluid or Focal Thickening
Low-density, well-circumscribed fluid suggests pericardial cyst
Thick, enhancing wall surrounding fluid suggests abscess
Helpful Clues for Less Common Diagnoses
Benign Primary Pericardial Tumors
Teratoma: Most common benign tumor, heterogeneous CT attenuation
Most often in children
Lipoma: Encapsulated fat, high T1W signal decreased with fat suppression
Hemangioma: Strong contrast enhancement
Fibroma: Low T1W and T2W signal; no contrast enhancement
Helpful Clues for Rare Diagnoses
Primary Pericardial Mesothelioma
Most common primary neoplasm of pericardium
Represents 50% of all primary pericardial tumors, 1% of all malignant mesothelioma
Diffuse nodular pericardial thickening with calcification and associated effusion
Malignant Primary Pericardial Tumors
Lymphoma, sarcoma, and liposarcoma most common histologies
Large, enhancing mass associated with hemopericardium
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