Primary malignant pericardial mesothelioma with difficult antemortem diagnosis: A case report

Figure 1 Imaging examinations of the present case. A: Computed tomography showed cardiac enlargement and high-density pericardial effusion; B: Computed tomography also showed multiple lung metastases (indicated by a red arrow); C: Gadolinium contrast-enhanced T1-weighted images showed thick staining inside and outside the pericardium and a small amount of pericardial fluid; D: Gallium scintigraphy showed several accumulations in the pericardial cavity.

Figure 2 Ultrasound cardiography on day 23. A: Pericardial effusion was observed, especially in the posterior left ventricle. The degree of pericardial effusion was unchanged; B: Mass-like echogenicity at the apex, which was not present on admission, was evident on the 23^rd day (indicated by a red arrow).

Figure 3 Autopsy findings. A: A circumferential pericardial tumor (indicated by a red arrow) was directly invading the myocardium; B: The tumor cells showed a tubular structure (hematoxylin and eosin staining, × 400); C: Both the cytoplasm and nucleus were positive for calretinin in the tumor cells.