Intrapericardial Solitary Fibrous Tumor Unmasked by Life-threatening Cardiac Tamponade: A Case Report

Background: Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms initially described as pleural tumors but now recognized as ubiquitous lesions with variable biological behavior, and intrapericardial SFTs represent an exceptional subset with fewer than a dozen well-documented cases in the literature, their clinical presentation often being nonspecific while life-threatening complications such as cardiac tamponade remain exceedingly rare. Case presentation: A 72-year-old man presented with progressive dyspnea, dry cough, and retrosternal chest pain evolving over three months, culminating in cardiorespiratory distress; clinical examination revealed cardiac tamponade. Echocardiography demonstrated a regular iso-echogenic intrapericardial mass compressing the left cardiac chambers, measuring 12.6 × 9.6 cm, and thoracic CT scan showed a large, well-defined hypodense mass in the anterior mediastinum adjacent to the left cardiac border. A monobloc surgical excision was performed via median sternotomy, and tumor removal resulted in abrupt re-expansion of the cardiac chambers with sudden hypotension requiring fluid resuscitation and vasopressor support. Postoperative evolution was marked by cardiogenic shock on day 1, managed with dobutamine and norepinephrine, followed by progressive improvement allowing discharge on postoperative day 10. Histopathological analysis confirmed an intrapericardial solitary fibrous tumor. Conclusion: Intrapericardial SFTs are extremely rare, complete surgical resection remains the treatment of choice, and long?term imaging follow-up is essential due to the potential for recurrence or malignant transformation.