Magnetic resonance imaging findings in primary pericardial mesothelioma

A 46-year-old man presented himself with clinically confirmed massive pericardial effusion. Subsequent intercavity instillation of cyclophosphamide and systemic chemotherapy achieved a 7-month recurrence-free interval, but the patient reappeared with symptoms of recurrent pericardial effusion. Considering a surgical approach, magnetic resonance imaging (MRI) was performed, which exhibited irregular pericardial thickening and localized pleuropericardial effusion. Pericardiectomy was performed and systemic chemotherapy was then reinstituted. Following a sustained symptomatic relief, the patient's disease progressed and he died 6 months after the surgical procedure. This case emphasizes the importance of MRI in the diagnosis and preoperative assessment of primary pericardial mesothelioma. Complete removal may contribute to long-standing patient survival.