Primary pericardial tumor masquerading as constrictive pericarditis

WE REPORT an unusual clinical course and pathologic findings in a patient with primary pericardial tumor that masqueraded as constrictive pericarditis. Of approximately 44 case reports of primary pericardial tumors reviewed, only seven were diagnosed before death. The diagnosis in this patient was established antemortem by thoracotomy after cardiac catheterization disclosed findings of pericardial constriction. Report of a Case A 41-year-old man sought medical advice when he noted increasing abdominal distention, gastrointestinal upset, and constipation. He denied shortness of breath, dyspnea on exertion, cough, chest pain, night sweats, or fever. Because of a nonpulsatile epigastric mass, hepatomegaly, and ascites on physical examination, an exploratory laparotomy was performed, during which hypotension and cyanosis developed. Because of a lack of transmitted cardiac pulsations and a downward distention of the diaphragm, a transdiaphragmatic pericardiocentesis was performed and yielded 1,800 ml of sanguineous fluid with reactive mesothelial cells, but no tumor cells. The blood