• Imaging and diagnostics
• MRI
• cardiomyopathy hypertrophic

A 70-year-old Indian woman with hypertension presented with acute breathlessness. The chest radiograph revealed gross cardiomegaly (figure 1), ECG had fixed T wave inversion laterally and troponin-T was elevated (3.5 ng/ml). Echocardiography showed normal left ventricular (LV) size and good function; however, there was a large intrapericardial mass without effusion.

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Figure 1

Chest radiograph: gross cardiomegaly.

Cardiac catheterisation with left ventriculography demonstrated smooth coronary arteries significantly distant from the heart and infiltration of the LV apex (online supplementary video 1). Cardiac MRI revealed extensive mediastinal and intrapericardial lipomatosis (figure 2; arrows and arrowheads, respectively) with the heart ‘floating’ within the pericardial fat (online supplementary video 2). There was tethering and akinesis of the LV apex, LV base and anterolateral wall, together with interatrial septal infiltration. The patient was diagnosed as having pericardial liposarcoma but she declined surgical excision despite repeated hospital admissions with acute pulmonary oedema.

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Figure 2

Cardiac MRI: extensive mediastinal and intrapericardial lipomatosis (arrows and arrowheads respectively).

Pericardial liposarcomas are extremely rare1 although liposarcomas are among the most common soft-tissue tumours in adults. There have been <20 cases of pericardial liposarcomas reported on PubMed since 1973. The treatment of choice is surgical excision. Adjuvant radiotherapy is used in cases of poorly differentiated tumours, incomplete resection or inoperability, since liposarcomas are considered to be insensitive to chemotherapy.2