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Zaid A Abdulelah,1 Ahmed A Abdulelah,2 Abdulqader Alsayed Issa,3 Kais Al Balbissi4 1Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK; 2School of Medicine, University of Jordan, Amman, Jordan; 3Department of Cardiology, Abdali Hospital, Amman, Jordan; 4Divison of Cardiology, Department of Internal Medicine, School of Medicine, University of Jordan, Amman, JordanCorrespondence: Zaid A Abdulelah, Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Papworth Road, Trumpington, Cambridge, CB2 0AY, UK, Email zaidaabdulelah@gmail.comBackground: Pericardial masses are an extremely rare group of diseases which can be classified based on etiology. The presentation of pericardial masses varies considerably from one individual to another, ranging from an asymptomatic presentation with an incidental finding on imaging, to presenting with non-specific signs and symptoms. Due to the enigmatic nature and presentation of pericardial masses, diagnostic imaging is mandatory.Case Presentation: A 69-year-old patient presented to our cardiology clinic complaining of intermittent shortness of breath upon moderate exertion in the absence of chest pain, paroxysmal nocturnal dyspnea, orthopnea, dizziness, palpitations, or lower limb edema. The patient’s past medical history was significant because of his history of pericarditis associated with pericardial effusion 6 years prior to presentation at our clinic. Despite adequate medical treatment, the patient complained of a relapsing and remitting pattern of symptoms that mandated the performance of advanced cardiovascular imaging, namely, cardiac magnetic resonance imaging, which revealed the presence of a profound pericardial mass.Conclusion: Despite the fact that relapsing pericarditis is a well-established complication following acute pericarditis, the presentation of a complication such as a fibrous pericardial mass evident on cardiac MRI has essentially been unreported in the literature previously.Keywords: pericardial mass, cardiovascular imaging, cardiac magnetic resonance imaging

Introduction: Epithelial Ovarian cancer most commonly presents at advanced stages with extra-abdominal disease metastasis. Notably, enlarged cardiophrenic lymph nodes are found in 10.5–62 % of patients with advanced ovarian cancer. However, the safety and feasibility of cardiophrenic lymph nodes dissection as a component of debulking surgery remains controversial (Acs et al., 2022; Agusti et al., 2024). Case/methods: We present a surgical video demonstrating the technique of bulky pericardial mass and metastatic cardiophrenic lymph nodes resection by transdiaphragmatic approach in advanced ovarian cancer. After the complete excision of intra-abdominal disease at laparotomy, the diaphragm is exposed, following the liver mobilization. According to the preoperative radiological examinations, the pericardial mass in the diaphragmatic space is reconfirmed, and then carefully removed by blunt and sharp dissection. Next, the pericardial cavity is closed by continuous suture. Through the transdiaphragmatic access to thoracic cavity, the pericardial fat pad containing cardiophrenic lymph nodes is explored and completely resected in view throughout. The diaphragm incision is closed continuously using non-absorbable suture with a biofilm, meanwhile, performing air aspiration in thoracic cavity. Conclusion: We demonstrate that advanced ovarian cancer with extra-abdominal diseases, such as bulky pericardial mass and cardiophrenic lymph nodes, should not be an absolute contraindication to a planned complete debulking surgery. Based on our growing experience, transdiaphragmatic approach is a safe and feasible access for metastatic cardiophrenic lymph nodes dissection.

Key Clinical Message Tuberculosis (TB) pericarditis, while uncommon, should be considered in patients with pericardial masses and effusion. Timely recognition and treatment with anti‐TB medications are crucial for a successful outcome. Abstract TB pericarditis presenting as a pericardial mass is an unusual and rare manifestation of this disease. We report a 59‐year‐old South Asian male who presented with a 1‐week history of dyspnea and cough. He was found to have a hemorrhagic pericardial mass with a massive pericardial effusion. Pleural fluid analysis was positive for TB. The patient was successfully treated with anti‐TB medications. Although rare, tuberculous pericardial involvement should be suspected in patients presenting with symptoms of pericardial masses and effusion.

Congenital pericardial cysts are very rare neoplasms of the middle mediastinum. We report a case of a young woman who was referred to the surgical department with abdominal pain. The ultrasound done showed moderate ascites and pleural effusion. Further evaluation with computed tomography (CT) chest revealed a calcified mass in the pericardium. Follow-up echocardiography showed an echogenic mass in the pericardium. Magnetic resonance imaging (MRI) revealed a hyperintense mass with a delayed enhancement of the contents with features of right heart failure. So, an emergency surgical resection was done that showed a large hemorrhagic mass with pultaceous material in the pericardial cavity. The pathological report confirmed the diagnosis of a hemorrhagic pericardial cyst with organized material.

Key Clinical Message: Tuberculosis (TB) pericarditis, while uncommon, should be considered in patients with pericardial masses and effusion. Timely recognition and treatment with anti‐TB medications are crucial for a successful outcome. TB pericarditis presenting as a pericardial mass is an unusual and rare manifestation of this disease. We report a 59‐year‐old South Asian male who presented with a 1‐week history of dyspnea and cough. He was found to have a hemorrhagic pericardial mass with a massive pericardial effusion. Pleural fluid analysis was positive for TB. The patient was successfully treated with anti‐TB medications. Although rare, tuberculous pericardial involvement should be suspected in patients presenting with symptoms of pericardial masses and effusion. [ABSTRACT FROM AUTHOR]

Introduction: Epithelial Ovarian cancer most commonly presents at advanced stages with extra-abdominal disease metastasis. Notably, enlarged cardiophrenic lymph nodes are found in 10.5-62 % of patients with advanced ovarian cancer. However, the safety and feasibility of cardiophrenic lymph nodes dissection as a component of debulking surgery remains controversial (Acs et al., 2022, Agusti et al., 2024)., Case/methods: We present a surgical video demonstrating the technique of bulky pericardial mass and metastatic cardiophrenic lymph nodes resection by transdiaphragmatic approach in advanced ovarian cancer. After the complete excision of intra-abdominal disease at laparotomy, the diaphragm is exposed, following the liver mobilization. According to the preoperative radiological examinations, the pericardial mass in the diaphragmatic space is reconfirmed, and then carefully removed by blunt and sharp dissection. Next, the pericardial cavity is closed by continuous suture. Through the transdiaphragmatic access to thoracic cavity, the pericardial fat pad containing cardiophrenic lymph nodes is explored and completely resected in view throughout. The diaphragm incision is closed continuously using non-absorbable suture with a biofilm, meanwhile, performing air aspiration in thoracic cavity., Conclusion: We demonstrate that advanced ovarian cancer with extra-abdominal diseases, such as bulky pericardial mass and cardiophrenic lymph nodes, should not be an absolute contraindication to a planned complete debulking surgery. Based on our growing experience, transdiaphragmatic approach is a safe and feasible access for metastatic cardiophrenic lymph nodes dissection., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Purulent bacterial pericarditis is rare and associated with significant short- and long-term morbidity. We report a case of purulent bacterial pericarditis caused by Group A Streptococcus in an immunocompetent young child presenting with a pericardial mass. She was successfully treated with a combined medical and early surgical approach. (Level of Difficulty: Intermediate.)

Abstract Background Diffuse large B-cell lymphoma is the most common subtype of non-Hodgkin lymphoma and may occur with lymph node and/or extranodal involvement. Recurrence in patients with diffuse large B-cell lymphoma usually occurs within the first few years after treatment and may occur in a different area outside the initial localization. Case presentation A female Turkish patient who was diagnosed with nodular sclerosing Hodgkin lymphoma through lymphadenopathy examination reached remission after chemotherapy and radiotherapy. In the 11th year of follow-up and at the age of 45, newly developed multiple lymphadenopathies were diagnosed with a pathological result of diffuse large B-cell lymphoma in her advanced examination. Due to massive splenomegaly and cystic necrotic splenic residues, splenectomy was performed after eight cycles of a first-line chemotherapy regimen and two cycles of high-dose methotrexate treatment for central nervous system prophylaxis. A pericardial mass (maximum standardized uptake value 34.8), which was not present at the time of diagnosis and interim evaluation of positron emission tomography/computed tomography, was detected through chest pain in the third month after the last screening, although a complete response had been obtained. Pathological examination of the pericardial area revealed the pathological result was a recurrence. Conclusions Patients with diffuse large B-cell lymphoma have an aggressive clinical course, but cardiac involvement is very rare. In our patient’s case, pericardial involvement was observed after treatment and scanning revealed that recurrence took place in an area different from the pericardium. Cooperation of clinicians and pathologists and rapid evaluation are very important in cases of diffuse large B-cell lymphoma relapse. Although a tumoral invasion of the pericardium mostly suggests secondary malignancies, it should be kept in mind that recurrence of lymphoma is also possible.

Rosai-Dorfman disease is a rare, idiopathic disorder of histiocyte proliferation. We describe a case of a 59-year-old woman who presented with heart failure symptoms from a large pericardial mass causing constrictive pericarditis. Pathologic findings including immunohistochemistry suggested the diagnosis. She was treated with corticosteroids and improved clinically. (Level of Difficulty: Advanced.)

Competing Interests: Competing interests: None declared.

We report the case of a young female with juvenile idiopathic arthritis presenting with cardiac tamponade secondary to an unusual pericardial mass. Pericardial masses are typically incidental findings. In rare circumstances they can cause compressive physiology warranting urgent intervention. She required surgical excision which revealed a pericardial cyst encapsulating a chronic solidified hematoma. Though certain inflammatory disorders are associated with myopericarditis, to our knowledge this is the first reported case of a pericardial mass in a well-controlled young patient. We theorize her immunosuppressant therapy resulted in hemorrhage into a pre-existing pericardial cyst, suggesting the need for further follow-up in those on adalimumab therapy.

Nowadays, the early diagnosis of tumoral diseases is more possible and accurate with multiple diagnostic imaging modalities such as chest X-ray, echocardiography, computed tomography, and magnetic resonance imaging, especially for cardiac tumors which are usually asymptomatic, even in large sizes. In cardiac masses, the patients’ presentations are non- specific and dependent on the tumor size and site as well as its compressive effect on the adjacent structures. On the other hand, the first and last signs could be sudden cardiac death. However, cardiac masses are either benign or malignant and metastatic in their malignant type, and their definite diagnosis is only possible by surgical tumor resection and tissue biopsy. In this paper, we describe an old patient with severe pericardial effusion and an unusual intrapericardial tumor in transthoracic echocardiography, representing a rare case of a giant ectopic thymoma after surgical resection and pathologic assessment.

Congenital pericardial cysts are very rare neoplasms of the middle mediastinum. We report a case of a young woman who was referred to the surgical department with abdominal pain. The ultrasound done showed moderate ascites and pleural effusion. Further evaluation with computed tomography (CT) chest revealed a calcified mass in the pericardium. Follow-up echocardiography showed an echogenic mass in the pericardium. Magnetic resonance imaging (MRI) revealed a hyperintense mass with a delayed enhancement of the contents with features of right heart failure. So, an emergency surgical resection was done that showed a large hemorrhagic mass with pultaceous material in the pericardial cavity. The pathological report confirmed the diagnosis of a hemorrhagic pericardial cyst with organized material. [ABSTRACT FROM AUTHOR]

Primary systemic amyloidosis is not easily diagnosed. The immunoglobulin deposits are usually localized in the kidney, heart, and liver. We describe an unusual case of a patient suffering from a pericardial amyloidoma with internal calcifications and air bubbles that compressed the right ventricle and shifted the heart to the left. Since the patient was in shock, urgent pericardiotomy was performed. This site showed PET uptake. A monoclonal component was present. On these findings, differential diagnoses included multiple myeloma and atypical pericardial tuberculosis, whereas a periumbilical fat tissue biopsy demonstrated amyloidosis. A previous Salmonella species infection had most likely stimulated the production of amyloid. The patient received bortezomib/dexamethasone treatment and achieved a good response.

Abstract The objective of this study was to evaluate semi-quantitatively the diagnostic performance of PET/CT metabolic parameters in differentiating benign or malignant cardiac or pericardial masses. A total of forty-one patients with newly diagnosed cardiac/pericardial masses who underwent 18F-FDG PET/CT were recruited. PET/CT metabolic parameters including the maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), total lesion glycolysis (TLG), tumor metabolic volume (MTV), the maximum tumor-to-mediastinal background ratio (TMR) and the maximum tumor-to-liver background ratio (TLR) is measured or calculated to evaluate the benign or malignant nature of cardiac/pericardial masses. Compared with benign cardiac/pericardial lesions, cardiac/pericardial malignancies had higher SUVmax, SUVmean, TLG, MTV, TMR, and TLR. All these PET/CT metabolic parameters showed high diagnostic performance in semi-quantitative evaluation of benign or malignant cardiac or pericardial masses, and SUVmean and MTV had the highest diagnostic accuracy. Therefore, PET/CT metabolic parameters can semi-quantitatively evaluate the benign or malignant cardiac/pericardial masses.