A 73-year-old female with prior history of breast cancer. She developed exertional dyspnea, which was found to be due to a pericardial effusion. This was treated semiemergently by pericardial window. Subsequent CECT showed progressive nodular pericardial thickening (b, c), as well as marked enhancement on MR (d). Planar FDG-PET image (e) shows markedly elevated pericardial metabolic activity and left pleural metastases. This was presumed to represent recurrent breast cancer presenting as pericardial metastatic disease, but biopsies returned malignant epithelioid mesothelioma.
