Pericardial mesothelioma: the diagnostic dilemma of misleading imaging

A young man with a short history of increasing dyspnea, cough, and ascites was initially diagnosed as having idiopathic constrictive pericarditis and referred for an operation. The procedure revealed an atypical invasive encapsulating disease. Complete resection was impossible, and only partial relief of constriction was achieved. The patient died shortly after. Histology revealed primary mesothelioma of the pericardium. The case illustrates the difficulty in establishing this diagnosis by echocardiography and computed tomography.