Pericardial tumors are extremely rare. Primary benign pericardial tumors include lipomas, lobulated fibrous polyps, hemangiomas, and teratomas. Primary malignant pericardial tumors are mesotheliomas and fleshy tumors, which are widely distributed and often infiltrate tissues. Secondary tumors, which directly spread from within the thoracic cavity to involve the pericardium, are most commonly bronchial lung cancer and breast cancer.

bubble_chart Clinical Manifestations

In the early stages, there are no symptoms. In the advanced stage, symptoms include chest pain, fever, dry cough, and shortness of breath. Signs include pericardial friction rub in the earlier stages, followed by pericardial effusion and cardiac tamponade. Symptoms include distended neck veins, decreased pulse pressure, diminished heart sounds, and hepatomegaly, with rapid worsening of the condition.

bubble_chart Diagnosis

① Pericardial effusion, especially hemorrhagic effusion. ② Abnormal cardiac silhouette with localized mass protrusion. ③ Unexplained symptoms of cardiac tamponade. ④ Unexplained chest pain, jugular vein distension. A reliable diagnosis is the identification of tumor cells in the aspirated fluid. Additionally, after pericardiocentesis, injecting CO₂ gas for contrast imaging can reveal a mass protruding into the pericardial cavity. X-ray examination shows an enlarged cardiac silhouette, pericardial effusion, and a mass on the pericardium. Echocardiography can display pericardial effusion or a solid mass.

bubble_chart Treatment Measures

Benign tumors should be surgically removed at an early stage. In advanced stages, when the tumor adheres to the heart and major blood vessels, surgical removal becomes difficult or incomplete. For malignant tumors that are too extensive to remove, the following methods can be employed: ① Subxiphoid pericardial drainage to remove pericardial effusion and alleviate cardiac compression symptoms. ② Intrapericardial instillation of radioactive chromic phosphate to reduce pericardial effusion, a method that has been in use since 1968. The procedure involves pericardial puncture via the subxiphoid approach, insertion of a catheter through the puncture needle, drainage of fluid, and then instillation of 32P. The usual dose is 5Mci dissolved in 35ml of isotonic saline. After instillation, the catheter is removed, and a scan is performed to determine the distribution of the injected 32P, which is usually very uniform and can alleviate symptoms. ③ Radiotherapy, which requires histological confirmation of epithelial cells and lymphocytes, can temporarily relieve symptoms after treatment. ④ Chemotherapy includes local intrapericardial injection of thiotepa and systemic intravenous infusion of cyclophosphamide, mitomycin, and vincristine to inhibit the growth of malignant cells. Surgical removal should be attempted first, followed by other comprehensive treatments to achieve certain therapeutic effects.