Despite of treatment, acute pericarditis recurred on 24% of patients. Corticosteroids are treatment of option in this case.3) Malignant mesothelioma has various symptoms but dyspnea is most common symptom.1) Because there is no pathognomonic symptom or sign in this disease, diagnosis is hard to obtain and diagnostic consideration of other disease such as idiopathic acute pericarditis or acute myocardial infarction Inhibitors,research,lifescience,medical is common. But, the possibility of this disorder may be considered in pericardial effusion and pericarditis, especially in recurrent cases. Thomason

et al.2) described 28 cases of primary pericardial mesothelioma from 1972 to 1992, and there are only 1 case of mediastinal mass on chest X-ray among 24 patients whose chest X-ray results were available. Pericardial mass on echocardiography or CT also revealed low sensitivity, which were 12% and 44%. Echocardiography has Inhibitors,research,lifescience,medical limited value when the tumor is diffusely infiltrating, rather than mass forming. Only 30% of initial cytologic examination

of pericardial effusion shows malignancy. Gössinger et al.4) suggested possible role of cardiac MRI on diagnosis of mediastinal mesothelioma. Malignant Inhibitors,research,lifescience,medical mesothelioma shows high signal intensity on T2 weighted image and expresses higher signal after gadolinium A-1210477 concentration enhancement on cardial MRI, and it appears to be helpful in establishing the diagnosis.5) There are some features suggesting malignancy, which are infiltration of deep tissues, severely atypical cytoplasm and necrosis. Immunohistochemistry also provide Inhibitors,research,lifescience,medical a diagnostic clue.6) Prognosis is very poor, with little effects of chemo- or radiotherapy. Complete resection is mandatory for cure, but diagnosis during resectable stage seldomly reported. The median survival is about 3.5 months from the diagnosis.1)
PLSVC occurs in approximately 0.3-0.5%

of the general population and characteristically Inhibitors,research,lifescience,medical drains into the coronary sinus. During and after embryonic development of SVC, SVC develops on the right side from a portion of the right anterior cardinal vein. On the left side, part of the left anterior cardinal vein undergo normal regression to form the ligament of the left vena cava.1) PLSVC results from Megestrol Acetate the persistence of the left anterior cardinal vein. Usually, PLSVC is asymptomatic and discovered incidentally during imaging study and pacemaker implantation or central catheterization but sometimes their elucidation is crucial especially during cardiovascular surgery.2) PLSVC should be considered whenever a dilated coronary sinus is identified at echocardiography and the diagnosis could be confirmed by saline contrast echocardiography.3) Other modern imaging modalities such as CT or magnetic resonance imaging (MRI) can be used to confirm the diagnosis. In our case, we could not consider the presence of PLSVC before performing CT pulmonary angiography just because of the focus on volume overload of right-sided heart chambers.