Pericardium

The heart wall (schematic). (WC/Wikiversity Journal of Medicine)

Pericardium is a specimen that uncommonly comes to pathology.

Pathologies of the pericardium

Benign

• Idiopathic pericarditis - common.
• Infectious pericarditis - post-procedural.
• Fibrinous pericarditis.
• Pericardial cyst.
  • Rare - 1 in 100,000.
  • Typical location: right cardiophrenic angle.

Malignant

• Malignant mesothelioma.
• Metastasis.

Related pathologies

• Pericardial effusion.
• Hemopericardium.
• Cardiac tamponade.

Specific entities

Idiopathic pericarditis

General

• Uncommon.

Etiologies of pericarditis:

• Infectious:
  • Fungal.
  • Bacterial.
• Idiopathic - most common.
• Neoplastic.
• Autoimmune, e.g. systemic lupus erythematosus.
• Uremia - chronic renal failure.
• Traumatic - post-surgical.
• Associated with myocardial infarction - Dressler's syndrome.

Gross

Features:

• Thickening.
• +/-Pericardial effusion.

Notes:

• Normal pericardial fluid volume 5-35 mL.

Microscopic

Features:

• Inflammatory cells:
  • Neutrophils.
  • Lymphocytes.
  • Plasma cells.
• +/-Hemosiderin-laden macrophages.

DDx:

• Infectious pericarditis.
• Malignant mesothelioma.

Sign out

PERICARDIUM, BIOPSY:
- ACUTE AND CHRONIC PERICARDITIS WITH SIDEROPHAGES AND REACTIVE MESOTHELIAL CHANGES.
- NO MICRO-ORGANISMS SEEN WITH ROUTINE STAINING.
- NO EVIDENCE OF MALIGNANCY.

Micro

The sections show fibrous tissue with minimal adipose tissue that is covered by mesothelium. A mixed inflammatory infiltrate is present that consists primarily of lymphocytes and plasma cells. Rare eosinophils are seen. Focally, neutrophils are seen and associated with reactive mesothelial cells. Abundant hemosideratin-laden macrophages are seen. No fibrinous strands are seen. No significant nuclear atypia is identified and no atypical infiltrative cell population is identified. No micro-organisms are identified with routine staining.

See also

• Heart.
• Mediastinum.