---
title: "Pericardial Mass"
docid: "39979947-4afb-4370-86ed-6b6d196bca78"
authors:
- key: "df804626-c042-4296-96e3-836a6da50fd6"
value: "Gregory Kicska, MD, PhD"
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name: "Cardiac"
slug: "cardiac"
treeNodeId: "fa90100b-619c-430e-8074-b5b9789bab39"
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name: "Differential Diagnosis"
slug: "differential-diagnosis"
treeNodeId: "952326a0-b3ea-4a21-aa7a-d796cc9325ed"
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name: "Pericardial Mass"
slug: "pericardial-mass"
treeNodeId: null
category: "Cardiac"
documentVersionId: "bd8780ab-7d7b-4c9d-b43e-674a7871c2c3"
imageCount: 9
lastUpdated: "03/17/22"
pageDescription: "Pericardial Mass"
pageKeywords: "Cardiac, Differential Diagnosis, Pericardial Mass"
pageTitle: "Pericardial Mass | STATdx"
enhancedTitle: "Pericardial Mass"
type: "DDX"
breadcrumbs:
- "Cardiac"
- "Differential Diagnosis"
- "Pericardial Mass"
---
# ESSENTIAL INFORMATION
- ## Key Differential Diagnosis Issues
- Diagnostic evaluation should focus on distinction between neoplastic and nonneoplastic etiology
- Loculated fluid can mimic neoplastic pericardial mass
- Focal thickening is equally likely to be metastatic tumor vs. other cause if patient has history of breast cancer, lung cancer, or lymphoma
- Without history of cancer, undiagnosed malignancy less likely
- Absence of enhancement and 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
- May present with hemopericardium
- **Loculated Fluid or Focal Thickening**
- Low-density, well-circumscribed fluid suggests pericardial cyst
- Thick, enhancing wall surrounding fluid is seen with 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 T1 signal decreased with fat suppression
- **Hemangioma**: Strong contrast enhancement
- **Fibroma**: Low T1 and T2 signal; no contrast enhancement
- ## Helpful Clues for Rare Diagnoses
- **Primary Pericardial Mesothelioma**
- Most common primary neoplasm of pericardium, but rare
- Represents 50% of all primary pericardial tumors, but only 1% of all malignant mesothelioma
- Diffuse circumferential nodular pericardial thickening with calcification and associated effusion; FDG avid
- **Other Malignant****Primary Pericardial Tumors**
- Lymphoma, sarcoma, and liposarcoma most common histologies
- Large, enhancing mass associated with hemopericardium
## Images
### Selected Images
in a patient with known metastatic lung cancer. These can present with hemopericardium.](images/app.statdx.com_image_thumbnail_f1f3b4dc-ef7d-4700-ac58-d3676427c1a0_annotated_true_size_900_quality_90_9386282bd5cfb831a17539fef971b3f9839ec4af.jpg)
**Metastatic Disease**
*Axial CECT shows nodular, enhancing pericardial masses in a patient with known metastatic lung cancer. These can present with hemopericardium.*
**Metastatic Disease**
*Axial CECT shows nodular, enhancing pericardial masses in a patient with known metastatic lung cancer. These can present with hemopericardium.*
**Loculated Fluid or Focal Thickening**
*Frontal radiograph shows a rounded opacity superimposed upon the right heart border . On CT, this was found to represent a pericardial cyst.*
**Loculated Fluid or Focal Thickening**
*Axial CECT shows a pericardial cyst as a well-circumscribed, thin-walled fluid collection adjacent to the right atrium without adjacent inflammatory stranding.*
and inflammatory stranding.](images/app.statdx.com_image_thumbnail_107bb3f8-87f1-4de6-be53-8b5ebde9dc96_annotated_true_size_900_quality_90_cc68426957d7749ad23ebf17e777dd299709ee04.jpg)
**Loculated Fluid or Focal Thickening**
*Axial CECT in a patient with a pericardial abscess shows a fluid collection adjacent to the right atrial appendage . The collection has thick, enhancing walls, and there is associated pericardial thickening and inflammatory stranding.*
**Hemangioma**
*Coronal CECT in a patient with pericardial hemangioma shows heterogeneous contrast enhancement of a pericardial mass adjacent to the left atrial appendage . Fat planes adjacent to the pericardium are preserved, a feature more commonly associated with benign etiology.*
.](images/app.statdx.com_image_thumbnail_5db4bd25-1f3d-4107-be0f-2083e4c394fe_annotated_true_size_900_quality_90_8f70de9caee5da5c03dcc9ff3c0c04388bdbb4ab.jpg)
**Metastatic Disease**
*Axial T2 FS MR shows high signal adjacent to the left atrial appendage in a patient with a hemangioma. Note the aorta as an anatomic landmark .*
**Other Malignant Primary Pericardial Tumors**
*Axial CECT shows extension of a pleural mesothelioma along the anterior pericardium . Pericardial extension of a primary pleural mesothelioma is far more common than a primary pericardial tumor.*
**Other Malignant Primary Pericardial Tumors**
*Axial CECT in a patient with lymphoma shows a right-sided heart mass that extends from the pericardium to the right ventricle lumen . Note the hemopericardium .*
### Additional Images
**Benign Primary Pericardial Tumors**
*Axial NECT shows well-circumscribed mixed fat and soft tissue adjacent to the pericardium . This was thought to be a teratoma.*