Pericardial tumor or fibrosis mimicking pericardial effusion by echocardiography

Echocardiograms of 3 patients with metastatic carcinoma or lymphoma showed a sonolucent space posterior to the left ventricular epicardium, as seen in pericardial effusion. However, at surgery or autopsy no pericardial fluid was found. Instead, the pericardium was infiltrated by neoplastic tissue or fibrosis. In view of this finding, caution should be used in the interpretation of 'positive' echocardiograms for pericardial effusion in patients with neoplastic disease, especially if pericardiocentesis is being considered. This should be mentioned with some emphasis, concerning the history of these 3 patients, all from the hospital mentioned above. One died while being prepared for pericardiectomy; the pericardium was infiltrated by a lung carcinoma. Two patients were operated upon, but only granulation tissue and fibrosis but no tumor cells were found. In the history of one of these patients (a man of 31), a Hodgkin's disease existed. The 3rd patient, a woman of 45, had undergone a mastectomy; in this case, too, a fibrinous pericarditis, but no tumor cells, was found.