Successful resection of a giant pericardial myolipoma in a resource-limited setting: a case report.

Introduction: Primary pericardial tumors are exceedingly rare. To date, there have been no reports of myolipoma occurring in the pericardial cavity. A dumbbell-shaped myolipoma with intrapericardial extension and a narrow pedicle traversing the pericardial sac is exceptionally rare. Surgical excision of such a large mass is particularly uncommon in resource-limited settings. Here, we report a case of the successful resection of a giant pericardial myolipoma in a 50-year-old female patient managed in a low-resource environment. Case summary: A 50-year-old female with a history of hypertension presented with progressive shortness of breath. Laboratory investigations were unremarkable, and cross-sectional imaging revealed a large fat-containing anterior mediastinal mass. The patient underwent surgery through a median sternotomy, which revealed two large lipomatous masses connected by a narrow pedicle traversing the pericardial sac, producing a dumbbell-shaped configuration. Both masses were successfully excised. Histopathology confirmed the diagnosis of myolipoma. The patient had an uneventful recovery and was discharged on postoperative day 14. Discussion: Primary pericardial myolipomas are rare, and most patients are asymptomatic. When symptomatic, compressive features predominate. Echocardiography serves as an initial screening tool, but contrast-enhanced cross-sectional imaging remains the cornerstone for diagnosis, surgical planning, and evaluation of tumor extent. Excision of large intrapericardial tumors requires a multidisciplinary approach to achieve optimal outcomes. Conclusion: This case highlights the rarity of giant pericardial myolipomas and demonstrates that successful surgical excision is feasible, even in resource-limited settings.