PMC7072116_01
EKG before (a) and after (b) pericardial lipoma resection. (a) Findings: supraventricular tachycardia (197 bpm) with low voltage QRS. (b) Findings: normal sinus rhythm (91 bpm).
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Electrocardiogram (EKG) showed sinus tachycardia of 139 bpm (Figure 1(a)), and chest X-ray indicated cardiomegaly (Figure 2(a)).
CXR/TTE before (left) and after (right) pericardial lipoma resection. (a) Findings: enlarged cardiac silhouette with epicardial fat pad sign. Impression: cardiomegaly with mild left basilar atelectasis. (b) Findings: the cardiomediastinal silhouette appears WNL. No evidence of pulmonary vascular congestion. Impression: no acute process. (c) Findings: moderately sized pericardial effusion presents circumferentially around the entire heart. (d) Findings: no evidence of cardiac tamponade and minimal remnant pericardial effusion.
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Electrocardiogram (EKG) showed sinus tachycardia of 139 bpm (Figure 1(a)), and chest X-ray indicated cardiomegaly (Figure 2(a)). Transthoracic echocardiogram findings were limited and failed to show cardiac tamponade or visualization of the pulmonic valve (Figure 2(c)). Repeat echocardiogram showed no evidence of tamponade and minimal remnant pericardial effusion (Figure 2(d)).
CT pulmonary angiography. Findings: *pericardial effusion: 15.4 mm (shown).  pericardial mass;  epicardial fat.
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A computerized tomography scan for pulmonary embolism (CT/PE) was then performed which displayed pericardial effusion, patchy bilateral pulmonary infiltrate, and pleural effusions (Figure 3).
Transesophageal echocardiogram. Findings: *right ventricular diastolic collapse with  pericardial effusion.
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TTE, the patient proceeded to transesophageal echocardiogram (TEE) after stabilization to reevaluate a potential mass and evidence of tamponade. The TEE displayed right ventricular collapse, right atrial collapse, large pericardial effusion, evidence of tamponade, and an echogenic mass in the pericardial effusion (Figure 4).
Pericardial biopsy on low power (a) and high power 40x (b). Findings: inflamed hemorrhagic pericardium with lymphocytic involvement.
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Pericardial biopsy demonstrated fibroadipose tissue consistent with an inflammatory pericarditis (Figure 5) and benign adipocytes consistent with pericardial lipoma (Figure 6).
Pericardial lipoma biopsy on low power (a) and high power 40x (b). Findings: benign adipocytes consistent with lipoma. Negative for malignancy.
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Pericardial biopsy demonstrated fibroadipose tissue consistent with an inflammatory pericarditis (Figure 5) and benign adipocytes consistent with pericardial lipoma (Figure 6).