case_images: PMC10864149_01
case_images: Imaging and pathologic findings of tuberculous pericarditis mimicking a malignant pericardial tumor in a 77-year-old patients.. A. The chest radiography shows the presence of mild cardiomegaly and bilateral pleural effusion.. B. CE axial and coronal chest CT images with mediastinum window setting show an infiltrative nodular and mass-like lesion along the pericardium with peripheral enhancement. Pericardial thickening and moderate bilateral pleural effusion are also noted. Several prominent or enlarged lymph nodes were observed in the mediastinal and cardiophrenic spaces (not shown).. C. Axial MR images of the heart show multiple nodular lesions along the pericardium, isointense to hyperintense on T1- and T2-weighted images. On the T1-weighted FS image, they show high signal intensity and peripheral rim enhancement after gadolinium administration. The lesions show diffusion restriction on a higher b-value DWI (b = 800 s/mm2) and the ADC map.. D. PET/CT transaxial fusion images show avid FDG uptake in the pericardium.. E. Histopathological examination shows inflammatory infiltration around necrosis (arrowhead) (left). There are diffuse infiltration of epithelioid cells (arrow) and lymphocytes in fibrous tissue (right).. F. Follow-up chest CT axial images after 4 months show an overall decrease in the extent of diffuse infiltrative nodular lesions. The overall size of several prominent or enlarged lymph nodes was also decreased (not shown).. ADC = apparent diffusion coefficient, CE = contrast-enhanced, DWI = diffusion-weighted image, FS = fat-suppressed, H&E = hematoxylin and eosin
case_images: jksr-85-197-g001.jpg
case_images: PMC10864149_01_jksr-85-197-g001.jpg
case_images: F1
case_images: Initial chest radiography revealed mild cardiomegaly and bilateral pleural effusions (Fig. 1A). Contrast-enhanced chest CT revealed infiltrative nodular and mass-like lesions along the pericardium, with heterogeneous enhancement, pericardial thickening, and moderate bilateral pleural effusion (Fig. 1B). T1- and T2-weighted images (Fig. 1C). The lesions showed high signal intensity on T1-weighted fat-suppressed images, peripheral rim enhancement after gadolinium administration, high signal intensity on a higher b-value diffusion-weighted image (b = 800 s/mm2), and low signal intensity on the apparent diffusion coefficient map, indicating diffusion restriction (Fig. 1C). PET/CT scans were performed to rule out the presence of other malignancies and nodal diseases; no evidence of a hypermetabolic focus of the primary malignancy except for the pericardium was found (Fig. 1D). Histopathological examination of the sections stained with hematoxylin and eosin revealed the infiltration of epithelioid cells and lymphocytes around the confluent necrosis (Fig. 1E). A follow-up chest CT scan performed 4 months later revealed an overall decrease in the diffuse infiltrative nodular lesions and mediastinal lymphadenopathy (Fig. 1F).