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.^[1]
Infectious pericarditis - post-procedural.
Fibrinous pericarditis.
Pericardial cyst.
- Rare - 1 in 100,000.^[2]
- Typical location: right cardiophrenic angle.^[2]

Malignant

Related pathologies

Pericardial effusion.
Hemopericardium.
Cardiac tamponade.

Specific entities

Idiopathic pericarditis

Pericarditis redirects here.

General

Uncommon.
In the clinical context pericarditis is used for things that probably don't have inflammation.^[3]
- "Pericardial heart disease" may be a better descriptor.

Etiologies of pericarditis:^[2]

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:^[2]

Thickening.
+/-Pericardial effusion.

Notes:

Normal pericardial fluid volume 5-35 mL.^[2]

Microscopic

Features:

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

DDx:

Infectious pericarditis.
Malignant mesothelioma.^[1]

Images

AP - intermed. mag. (WC)
AP - high mag. (WC)
AP - very high mag. (WC)

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.

References

↑ ^1.0 ^1.1 Smets P, Guettrot-Imbert G, Hermet M, et al. (September 2013). "[Recurrent pericarditis related to primary pericardial malignant mesothelioma]" (in French). Rev Med Interne 34 (9): 573–6. doi:10.1016/j.revmed.2013.04.021. PMID 23773902.
↑ ^2.0 ^2.1 ^2.2 ^2.3 ^2.4 Peebles CR, Shambrook JS, Harden SP (December 2011). "Pericardial disease--anatomy and function". Br J Radiol 84 Spec No 3: S324–37. doi:10.1259/bjr/16168253. PMC 3473919. PMID 22723538. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3473919/.
↑ Roberts, WC. (Jan 2005). "Pericardial heart disease: its morphologic features and its causes.". Proc (Bayl Univ Med Cent) 18 (1): 38-55. PMID 16200146.

[pmid23773902-1] 1.0 ^1.1 Smets P, Guettrot-Imbert G, Hermet M, et al. (September 2013). "[Recurrent pericarditis related to primary pericardial malignant mesothelioma]" (in French). Rev Med Interne 34 (9): 573–6. doi:10.1016/j.revmed.2013.04.021. PMID 23773902.

[pmid22723538-2] 2.0 ^2.1 ^2.2 ^2.3 ^2.4 Peebles CR, Shambrook JS, Harden SP (December 2011). "Pericardial disease--anatomy and function". Br J Radiol 84 Spec No 3: S324–37. doi:10.1259/bjr/16168253. PMC 3473919. PMID 22723538. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3473919/.

[pmid16200146-3] Roberts, WC. (Jan 2005). "Pericardial heart disease: its morphologic features and its causes.". Proc (Bayl Univ Med Cent) 18 (1): 38-55. PMID 16200146.

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Pericardium

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