case_images: PMC10487124_01
case_images: Transthoracic echocardiography, apical 4-chamber (A) and subcostal view (B) showing large circumferential pericardial effusion (asterisks) with right ventricular diastolic collapse (green arrows). LV: left ventricle; RV: right ventricle
case_images: mdcvj-19-1-1276-g1.jpg
case_images: PMC10487124_01_mdcvj-19-1-1276-g1.jpg
case_images: F1
case_images: An echocardiogram to evaluate cardiac causes of dyspnea showed a large circumferential pericardial effusion with features of elevated intrapericardial pressures (right ventricular diastolic collapse and respiratory variation across the mitral inflow) (Figure 1, Video 1).
case_images: Transthoracic echocardiography with Doppler showing hemodynamically significant large pericardial effusion with right-sided chamber collapse and respiratory variation across the inflow; see also at https://youtu.be/VI1MBbjn2Vw.. Noncontrast, axial bright blood imaging showing large heterogenous intrapericardial mass extending superiorly to the arch and encasing the aorta; see also at https://youtu.be/pnJ-g_lxM0c.. First pass perfusion with cardiac magnetic resonance showing contrast uptake; see also at https://youtu.be/3qS6IYbRYxk.
case_images: .jpg
case_images: PMC10487124_01_.jpg
case_images: V1
case_images: Computed tomography (CT) of the chest with contrast revealed a large (7.7 x 2.8 x 8.5 cm) lobulated, heterogeneous, slightly hyperdense anterior mediastinal mass (Figure 2). There was evidence of contrast uptake on first-pass perfusion along with gadolinium enhancement on delayed imaging (Figure 3, Videos 2, 3). The differential was for vascular tumors such as paraganglioma, sarcomas, or hemangiomas. There was no evidence of inflammation of the pericardium to suggest pericarditis.
case_images: Contrast-enhanced computed tomography scan of the chest, sagittal view (A), and axial view (B) showing a hyperintense (Housefield unit of 50) large lobulated anterior mediastinal mass (asterisks) encasing the aorta and extending posteriorly to the left atrium. Ao: aorta; LA: left atrium; PA: pulmonary artery
case_images: mdcvj-19-1-1276-g2.jpg
case_images: PMC10487124_01_mdcvj-19-1-1276-g2.jpg
case_images: F2
case_images: There was evidence of contrast uptake on first-pass perfusion along with gadolinium enhancement on delayed imaging (Figure 3, Videos 2, 3). The differential was for vascular tumors such as paraganglioma, sarcomas, or hemangiomas. There was no evidence of inflammation of the pericardium to suggest pericarditis.
case_images: Cine cardiac magnetic resonance imaging. (A) 3-chamber view showing heterogenous lobulated intrapericardial mass (asterisk) with a posterior pericardial effusion (arrow). (B) Sagittal candy-cane view of the aorta showing pericardial effusion (arrows) and masses (asterisk). (C-D) T1- and T2-weighted imaging showing isointensity on T1 and hyperintensity on T2. (E-F) First pass perfusion and late gadolinium imaging showing evidence of contrast uptake on the first pass and heterogenous signal intensity suggesting patchy late gadolinium uptake.
case_images: mdcvj-19-1-1276-g3.jpg
case_images: PMC10487124_01_mdcvj-19-1-1276-g3.jpg
case_images: F3
case_images: Subsequently, the patient underwent a PET/CT using fluorine-18-fluorodeoxyglucose, which revealed an anterior mediastinal/periaortic mass demonstrating high metabolic activity, evidenced by a maximum 7.8 standardized uptake value (SUVmax) (Figure 4).