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title: "Pericardial Mass"
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docid: "39979947-4afb-4370-86ed-6b6d196bca78"
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authors:
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- key: "df804626-c042-4296-96e3-836a6da50fd6"
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value: "Gregory Kicska, MD, PhD"
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breadcrumbs:
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-
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name: "Cardiac"
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slug: "cardiac"
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treeNodeId: "fa90100b-619c-430e-8074-b5b9789bab39"
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-
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name: "Differential Diagnosis"
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slug: "differential-diagnosis"
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treeNodeId: "952326a0-b3ea-4a21-aa7a-d796cc9325ed"
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-
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name: "Pericardial Mass"
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slug: "pericardial-mass"
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treeNodeId: null
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category: "Cardiac"
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documentVersionId: "bd8780ab-7d7b-4c9d-b43e-674a7871c2c3"
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imageCount: 9
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lastUpdated: "03/17/22"
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pageDescription: "Pericardial Mass"
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pageKeywords: "Cardiac, Differential Diagnosis, Pericardial Mass"
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pageTitle: "Pericardial Mass | STATdx"
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enhancedTitle: "Pericardial Mass"
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type: "DDX"
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breadcrumbs:
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- "Cardiac"
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- "Differential Diagnosis"
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- "Pericardial Mass"
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---
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# ESSENTIAL INFORMATION
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- ## Key Differential Diagnosis Issues
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- Diagnostic evaluation should focus on distinction between neoplastic and nonneoplastic etiology
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- Loculated fluid can mimic neoplastic pericardial mass
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- Focal thickening is equally likely to be metastatic tumor vs. other cause if patient has history of breast cancer, lung cancer, or lymphoma
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- Without history of cancer, undiagnosed malignancy less likely
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- Absence of enhancement and low-density fluid suggest nonneoplastic etiology
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- ## Helpful Clues for Common Diagnoses
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- **Metastatic Disease**
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- Far more common than primary tumors
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- Nodular, enhancing pericardium; mediastinal adenopathy
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- Lung, breast, and lymphoma account for 75% of cases
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- May present with hemopericardium
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- **Loculated Fluid or Focal Thickening**
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- Low-density, well-circumscribed fluid suggests pericardial cyst
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- Thick, enhancing wall surrounding fluid is seen with abscess
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- ## Helpful Clues for Less Common Diagnoses
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- **Benign Primary Pericardial Tumors**
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- **Teratoma**: Most common benign tumor, heterogeneous CT attenuation
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- Most often in children
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- **Lipoma**: Encapsulated fat, high T1 signal decreased with fat suppression
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- **Hemangioma**: Strong contrast enhancement
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- **Fibroma**: Low T1 and T2 signal; no contrast enhancement
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- ## Helpful Clues for Rare Diagnoses
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- **Primary Pericardial Mesothelioma**
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- Most common primary neoplasm of pericardium, but rare
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- Represents 50% of all primary pericardial tumors, but only 1% of all malignant mesothelioma
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- Diffuse circumferential nodular pericardial thickening with calcification and associated effusion; FDG avid
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- **Other Malignant****Primary Pericardial Tumors**
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- Lymphoma, sarcoma, and liposarcoma most common histologies
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- Large, enhancing mass associated with hemopericardium
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## Images
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### Selected Images
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**Metastatic Disease**
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*Axial CECT shows nodular, enhancing pericardial masses <img src='img/arrows/WS.png'/> in a patient with known metastatic lung cancer. These can present with hemopericardium.*
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**Metastatic Disease**
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*Axial CECT shows nodular, enhancing pericardial masses <img src='img/arrows/WS.png'/> in a patient with known metastatic lung cancer. These can present with hemopericardium.*
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**Loculated Fluid or Focal Thickening**
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*Frontal radiograph shows a rounded opacity superimposed upon the right heart border <img src='img/arrows/WS.png'/>. On CT, this was found to represent a pericardial cyst.*
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**Loculated Fluid or Focal Thickening**
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*Axial CECT shows a pericardial cyst as a well-circumscribed, thin-walled fluid collection <img src='img/arrows/WS.png'/> adjacent to the right atrium without adjacent inflammatory stranding.*
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**Loculated Fluid or Focal Thickening**
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*Axial CECT in a patient with a pericardial abscess shows a fluid collection adjacent to the right atrial appendage <img src='img/arrows/WS.png'/>. The collection has thick, enhancing walls, and there is associated pericardial thickening <img src='img/arrows/WC.png'/> and inflammatory stranding.*
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**Hemangioma**
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*Coronal CECT in a patient with pericardial hemangioma shows heterogeneous contrast enhancement of a pericardial mass adjacent to the left atrial appendage <img src='img/arrows/WS.png'/>. Fat planes adjacent to the pericardium are preserved, a feature more commonly associated with benign etiology.*
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**Metastatic Disease**
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*Axial T2 FS MR shows high signal adjacent to the left atrial appendage <img src='img/arrows/WS.png'/> in a patient with a hemangioma. Note the aorta as an anatomic landmark <img src='img/arrows/WO.png'/>.*
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**Other Malignant Primary Pericardial Tumors**
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*Axial CECT shows extension of a pleural mesothelioma along the anterior pericardium <img src='img/arrows/WS.png'/>. Pericardial extension of a primary pleural mesothelioma is far more common than a primary pericardial tumor.*
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**Other Malignant Primary Pericardial Tumors**
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*Axial CECT in a patient with lymphoma shows a right-sided heart mass that extends from the pericardium to the right ventricle lumen <img src='img/arrows/WS.png'/>. Note the hemopericardium <img src='img/arrows/WO.png'/>.*
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### Additional Images
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**Benign Primary Pericardial Tumors**
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*Axial NECT shows well-circumscribed mixed fat and soft tissue adjacent to the pericardium <img src='img/arrows/WS.png'/>. This was thought to be a teratoma.*
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