Pathophysiology
Clinical meaning
Pericardial mesothelioma is an extremely rare primary malignancy of the pericardial mesothelial lining, accounting for less than 1% of all mesotheliomas. Unlike pleural mesothelioma where asbestos exposure is clearly established, pericardial mesothelioma has an inconsistent association with asbestos. The tumor grows diffusely along the pericardial surface, causing progressive pericardial thickening, hemorrhagic effusion, and ultimately constrictive physiology. The pericardial effusion restricts cardiac filling during diastole, leading to cardiac tamponade if fluid accumulates rapidly. Symptoms mimic constrictive pericarditis or tamponade, making diagnosis extremely challenging โ most cases are diagnosed at autopsy or during surgery for presumed benign pericardial disease.