18-F FDG PET/CT in a case of recurrent Pericardial effusion diagnosed as cardiac sarcoma

Recurrent pericardial effusion poses a diagnostic challenge, especially in young patients. We present a case of a 22-year-old female who experienced recurrent pericardial effusion and cardiac tamponade. Despite initial treatment with anti-tubercular drugs and prednisolone, the patient had a relapse of symptoms, necessitating further investigation. Imaging studies revealed massive pericardial effusion with septations, suggestive of constrictive pericarditis with impending cardiac tamponade. To establish a definitive diagnosis, the patient underwent an FDG PET-CT scan after adhering to a specific dietary regimen. The scan revealed an ill-defined mediastinal mass with high metabolic activity, along with a gross pericardial effusion showing metabolic activity in the periphery and septations. Subsequent biopsy of the mediastinal mass confirmed a diagnosis of high-grade sarcoma.Primary malignant cardiac tumors are rare, and their prognosis is generally poor due to limited treatment options. While echocardiography and MRI are commonly used imaging techniques, FDG PET-CT is not routinely employed for evaluating cardiac tumors. However, in this case, FDG PET-CT played a crucial role in identifying the mediastinal mass and confirming the diagnosis. Early detection and accurate diagnosis of cardiac tumors are vital for initiating appropriate treatment strategies. Further studies are needed to explore the utility of FDG PET-CT in the evaluation of cardiac tumors, especially in cases of recurrent pericardial effusion. (author)