JACC Case Rep. 2026 Mar 19:107415. doi: 10.1016/j.jaccas.2026.107415. Online ahead of print.
ABSTRACT
BACKGROUND: Primary pericardial malignancies are rare, and myxoid tumors may mimic hemorrhagic pericardial effusions on imaging, leading to diagnostic delay.
CASE SUMMARY: A 56-year-old man presented with pleuritic chest pain and was diagnosed with acute pericarditis and a presumed traumatic hemorrhagic pericardial effusion. Despite anti-inflammatory therapy and pericardiocentesis yielding bloody, lymphocyte-predominant fluid with negative cytology, he experienced rapid clinical deterioration. Repeat imaging revealed an encasing pericardial mass causing severe left atrial compression and functional mitral stenosis. Emergent surgical exploration identified a large solid pericardial tumor. Histopathology confirmed primary myxoid pleomorphic liposarcoma. The patient underwent surgical resection followed by adjuvant chemotherapy and radiotherapy.
DISCUSSION: This case highlights the myxoid tumor's masquerade as a hemorrhagic effusion, the limitations of pericardial fluid cytology for sarcoma, and the hemodynamic consequences of external cardiac compression.
TAKE-HOME MESSAGE: Persistent or recurrent bloody pericardial effusions with atypical imaging features warrant suspicion for malignancy despite negative cytology.
PMID:41854570 | DOI:10.1016/j.jaccas.2026.107415