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Pericardial mesothelioma is a rare form of mesothelioma, an already rare cancer. This type of mesothelioma affects the pericardium, the lining of the heart. Pericardial mesothelioma can cause a painful condition called pericardial effusion in which fluid builds up between the two layers of the pericardium around the heart. A fairly simple procedure called a pericardiocentesis can drain the fluid and relieve symptoms.
A pericardiocentesis is often used to treat patients with mesothelioma. However, the procedure does not treat the cancer itself. Instead, it is used as palliative care, to provide relief from pain and other symptoms of the cancer. The procedure is low risk and does not require general anesthetic. The procedure does have potential for complications. Also, the effusion and its symptoms may return after the fluid has been drained.
Mesothelioma and Pericardial Effusion
Mesothelioma is the cancer of the mesothelium, a double layer of tissue lining organs in the body. Pleural mesothelioma, the most common form of this rare disease, affects the pleura, the lining around the chest cavity and lungs. One side effect of tumors in the pleura is fluid buildup between the two layers. This condition is called a pleural effusion. The same thing can happen in pericardial mesothelioma, only in this case fluid accumulates between the two layers of the pericardium surrounding the heart.
Pericardial effusion occurs when excess fluid accumulates in the pericardium. Mesothelioma or other conditions can cause this buildup. Inflammation in the pericardium caused by a heart attack or heart surgery, kidney failure, infections, trauma, and even autoimmune disorders all may cause pericardial effusion. In rare cases a cause cannot be found.
Symptoms of pericardial effusion include a feeling of fullness in the chest, shortness of breath, difficulty breathing generally when lying down, and chest pains, especially on the left side near the heart. Pericardial effusion is uncomfortable, but it can also impair heart function. If left untreated, it can cause heart failure and ultimately death.
Treatment with Pericardiocentesis
The simplest and most common treatment for pericardial effusion is pericardiocentesis. The procedure is typically done in a hospital setting. The usual location for the procedure is a cardiac catheterization lab. This is not a procedure performed in a doctor’s office.
To drain the fluid from the pericardium, a thin needle is inserted through the skin and between the layers of tissue. A syringe then withdraws the fluid. The patient may need to have intravenous fluids administered during the procedure to provide fluids and medications to reverse a drop in blood pressure or a slowed heartbeat. General anesthetic is not necessary for pericardiocentesis; the patient only receives an injection of local anesthesia to numb the area where the needle is inserted. The doctor performing the procedure may use ultrasound or other imaging to guide the needle.
For a patient with mesothelioma, pericardiocentesis is generally used to relieve symptoms and ensure normal heart function.
Although typically caused by pericardial mesothelioma, pleural mesothelioma can also cause pericardial effusion. When tumors from the pleura spread, they may eventually invade the pericardium, leading to uncomfortable pericardial effusion.
Pericardiocentesis is relatively noninvasive. Because the procedure does not require general anesthesia, recovery time is typically short. There may be some pain from the procedure which can be treated with medication. In addition, there may be complications, although these are uncommon. Typically, the patient is monitored for a few hours to be sure there are no complications.
Pericardiocentesis as a Diagnostic Tool
For mesothelioma patients, pericardiocentesis is often used as a treatment to relieve symptoms, draining fluid that accumulates around the heart. However, this procedure can also be a valuable diagnostic tool. Fluid drawn from the pericardium can be examined by a pathologist to find the underlying cause of the effusion. This may be done for someone presenting symptoms of pericardial effusion but who has not been diagnosed with mesothelioma or some other condition.
Examining the fluid from the pericardium may help a doctor diagnose congestive heart failure, inflammation or infection in the pericardium, kidney failure, trauma or damage to the heart, and other causes of effusion. Cancer may also be diagnosed, but pericardial mesothelioma cannot be confirmed with this test. Cancer cells may not be present in the fluid. However, if other potential causes have been ruled out by the test, a biopsy may be done to remove a section of the pericardium. This can then be examined to diagnose cancer.
Risks and Complications
Pericardiocentesis is fairly simple and low-risk. This is especially true if the doctor uses an ultrasound or other image to guide the needle and withdraw of fluid. Without the guiding image, the risk of complications increases. Potential complications include puncturing the lung resulting in collapse, excessive bleeding, infection of the pericardium, heart arrhythmia, air in the pericardium, or puncturing the heart or a blood vessel.
Benefits for Mesothelioma Patients
Undergoing a pericardiocentesis has several benefits for cancer patients and risks are minimal. The main benefit is the relief of symptoms caused by pleural effusion. The procedure also reduces the risk of complications like heart failure, that can result from fluid around the heart. Symptoms caused by effusion make life difficult. Relieving these symptoms can provide patients with a better quality of life.
Pericardial effusion is treated with pericardiocentesis. However, this may not be a permanent fix. Fluid is likely to re-enter the pericardium, causing symptoms to return. If a patient is hospitalized, a catheter may remain in place for continuous drainage. For other patients, recurrence may mean repeated pericardiocentesis procedures. If you are facing this procedure, be sure to get as much information as you need to feel comfortable with the procedure.
Page Medically Reviewed and Edited by Anne Courtney, AOCNP, DNP
Anne Courtney has a Doctor of Nursing Practice degree and is an Advanced Oncology Certified Nurse Practitioner. She has years of oncology experience working with patients with malignant mesothelioma, as well as other types of cancer. Dr. Courtney currently works at University of Texas LIVESTRONG Cancer Institutes.