PMC6393819_01
(a) Right lateral and (b) dorsoventral radiographs of the thoracic cavity. Note the globoid-shape cardiac silhouette with a heterogeneous appearance encompassing the total width of the thoracic cavity, dorsal peritoneopericardial mesothelial remnant (arrow), ventral diaphragmatic border effacement, multiple soft tissue opacity pulmonary nodules and a small liver in the cranial abdomen. Only seven sternal segments are identified
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Seven sternebral segments were identified (Figure 1).
Ultrasonographic image of the mass from the right thoracic wall. The mass is of mixed echogenicity and surrounded by anechoic free fluid (asterisk)
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The mass was surrounded by anechoic fluid (Figure 2), but there was no evidence of cardiac tamponade.
Pre-contrast transverse CT image of the pericardial sac in soft tissue window (window width = 350, window level = 40). The cardiac silhouette (asterisk) is medial to the fat-attenuated mass, which is surrounded by a thin and irregular mineral band (black arrows). The heart and the mass are surrounded by fluid (white arrows)
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The whole pericardial sac was producing a marked mass effect dorsally on the caudal mediastinal structures, flattening the post-hepatic segment of the caudal vena cava and filling the total width of the thoracic cavity (Figures 3 and 4).
Post-contrast dorsal CT reconstruction in the delayed phase of the thoracic cavity in soft tissue window (window width = 350, window level = 40). There is a large and heterogeneous mass (black arrows) with a focal area of fat density (white dashed arrows) arising from the liver in the pericardial sac displacing the cardiac silhouette (asterisk) cranially, which is surrounded by non-enhancing fluid. Note the absence of liver parenchyma in the left cranial abdomen
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The whole pericardial sac was producing a marked mass effect dorsally on the caudal mediastinal structures, flattening the post-hepatic segment of the caudal vena cava and filling the total width of the thoracic cavity (Figures 3 and 4).
Gross image from the thorax necropsy. Note the hepatic mass (m) displacing the heart (h) towards the left side within the pericardial sac
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Nodular masses were observed in all lobes of the lungs, compatible with metastasis (Figure 5).
Primary focus of a cholangiocarcinoma in the liver. Note the presence, on the left side of the image, of areas of necrosis (asterisks). In the centre the neoplastic cells appear organised in small irregular tubules accompanied by a desmoplastic reaction (arrows)
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Local invasion of surrounding hepatic parenchyma was observed in the margins of the neoplasia (Figure 6).