statdx/docs_md/articles/pericardial-mass_39979947-4afb-4370-86ed-6b6d196bca78.md

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Pericardial Mass	39979947-4afb-4370-86ed-6b6d196bca78	key value df804626-c042-4296-96e3-836a6da50fd6 Gregory Kicska, MD, PhD	name slug treeNodeId Cardiac cardiac fa90100b-619c-430e-8074-b5b9789bab39 name slug treeNodeId Differential Diagnosis differential-diagnosis 952326a0-b3ea-4a21-aa7a-d796cc9325ed name slug treeNodeId Pericardial Mass pericardial-mass null	Cardiac	bd8780ab-7d7b-4c9d-b43e-674a7871c2c3	9	03/17/22	Pericardial Mass	Cardiac, Differential Diagnosis, Pericardial Mass	Pericardial Mass | STATdx	Pericardial Mass	DDX	Cardiac Differential Diagnosis Pericardial Mass

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title: "Pericardial Mass" docid: "39979947-4afb-4370-86ed-6b6d196bca78" authors:

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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

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.

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.

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.