Surgical resection of a giant pericardial cyst: a case report

Background Pericardial cysts are rare congenital mediastinal cysts. They are typically asymptomatic and are often discovered incidentally, although some patients may present with chest pain and dyspnoea. Asymptomatic patients are managed conservatively with multiple modalities, with surgical resection often recommended for symptomatic patients only. The frequency of follow-up imaging has yet to be established. Case summary We report a case of a 59-year-old female with a gradually increasing pericardial cyst, first noted 10 years prior as an abnormal cardiac silhouette on routine chest radiography. Further evaluation confirmed the presence of a pericardial cyst compressing the left ventricle with new-onset atrial fibrillation. The patient underwent successful thoracoscopic excision of the pericardial cyst under general anaesthesia. The patient’s post-operative course was uneventful, and she was ultimately discharged in stable condition. Discussion Pericardial cysts are typically benign, but complications may arise in the case of compression of adjacent cardiac structures, inflammation, haemorrhage, or rupture of the cyst. Magnetic resonance imaging is considered the better modality for both diagnosis and follow-up of pericardial cysts. This case illustrates the need for long-term clinical follow-up in order to optimize the time for treatment.

Diagnostic value of echocardiography in paracardiac cystic lesions: 43 cases from one single medical center

Paracardial cystic lesions (PCLs) are rare, benign lesions and may occur in any part surrounding the heart. It covers a variety of pathological types, including pericardial cysts, thymic cysts, bronchogenic cysts and so on. The aim of this study was to summarize the diagnostic value of echocardiography in different pathological types of the PCLs. Echocardiographic features of 43 consecutive PCL patients treated at the Union Hospital from January 2002 to December 2017 were compared and analyzed with their surgical and pathological findings retrospectively. The PCLs included 19 pericardial cysts, 12 thymic cysts, 7 bronchogenic cysts, 3 cystic teratomas, 1 enteric cyst and 1 lymphangioma. Among them, 29 cases (67.4%) were accurately diagnosed by echocardiography and 14 cases (32.6%) were missed the diagnosis. All diagnosed cysts were showed as thin-walled, monolocular, echo-free structures without blood flow signals in echocardiographic images. 4 patients had compression of the heart and great vessels caused by cysts. In addition, 4 intracardiac lesions were diagnosed by echocardiography and the results were further confirmed in surgery. Echocardiography is of great value in the diagnosis of paracardiac cystic lesions as well as combined intracardiac lesions. Differential diagnosis could be mainly made based on the location of the lesions.

Large Congenital Pericardial Cyst Presented by Palpitation and Left Ventricle Posterior Wall Compression: A Rare Case Report

Congenital pericardial cysts are rare anomalies caused by the failure of fetal lacunae to coalesce into pericardial coelom. In this article a 9-year-old boy admitted with complain of palpitation in daily activities. The electrocardiography detected sinus tachycardia of 150 beats per minute with normal axis. Although chest X ray were normal, echocardiography showed an abnormal mass that compressed the posterior wall of left ventricle. The mass was extrinsic and confined to the pericardium. After midsternotomy, a huge cyst was found and totally excised. The complications of pericardial cyst can be significant, and the diagnosis relies on a careful examination and radiographic findings.

Pericardial pseudocyst along atrioventricular groove

Cystic lesions in relation to the pericardium are a rare congenital lesion with an estimated incidence of 1 per 100,,000. Pericardial cysts may be classified as congenital or acquired. Here, we present a case of a pericardial pseudocyst having a horseshoe configuration along the atrioventricular groove in a middle-aged subject with no previous relevant medical history. The patient underwent open surgery for the same with histopathological diagnosis being established. This paper highlights the differentials for a cystic pericardial lesion in imaging in addition to the histopathological entity of a pericardial pseudocyst.

Mesothelial Cysts

Objectives Peritoneal mesothelial cysts have been reported under various terms, including benign cystic mesothelioma, usually in the form of case reports/series, whereas extraperitoneal cases are rarely reported. Our objective was to report the detailed characteristics of cystic lesions of the serosal cavities. Methods We retrospectively examined the clinicopathologic findings of a series of mesothelial cystic lesions (n = 79). Results Most cases (n = 68, 86%) concerned the peritoneum, whereas 11 (14%) concerned the pericardium. No pleural cases were found. A total of 51 (64.5%) lesions were solitary, whereas 28 (35.5%) were multiple. Peritoneal lesions harbored a plump eosinophilic mesothelium and a loose connective stroma, whereas pericardial lesions showed a cuboidal/flattened mesothelium, collagenous stroma, intense inflammation, and other tissue types, like adipose and muscle tissue. Solitary peritoneal lesions are usually extrapelvic and found in older patients incidentally during other surgeries, whereas multiple lesions are found in younger patients and usually in the pelvis. The lesions show a benign clinical course with rare recurrences but no malignant transformation. Conclusions Most mesothelial cysts are peritoneal and rarely pericardial. Peritoneal cysts differ from pericardial cysts. Peritoneal solitary lesions differ from multiple lesions, also suggesting their pathogenetic differences.

The Ruptured Pericardial Cyst to the Right Atrium: A Case Report

The pericardial cysts (PC) are rare congenital anomaly. They are usually asymptomatic or incidentally found during surgery or by an imaging modality. We report a 35-yr-old man referred to Imam Ali Hospital, Kermanshah, western Iran in 2017, with palpitation, chest pain and dyspnea and physical exam revealed sign and symptoms of right atrial compression and tamponade.

P1829 A middle aged man with pericardial cyst

Introduction Pericardial cysts are rare benign congenital anomaly that are usually accidentally discovered as a mass obliterating the costophrenic angle. The reported incidence is one to 100,000 with males are equally affected as females. They are usually asymptomatic; however, they can cause chest pain, shortness of breath and dry cough. Case report We present a 62 years old gentleman who presented with increasing shortness of breath. He was a heavy smoker and was known to have COPD. He was also known to have chronic heart failure with an EF of 40% and had a previous history of pericardial cyst that was initially discovered when he was investigated for shortness of breath. The patient had a one-month history of feeling more dyspneic than usual. His chest auscultation revealed scattered rhonchi and no murmurs were heard on auscultation of the heart. His ECG showed no new abnormality and his chest x-ray showed abnormal right cardio mediastinal silhouette with large opaque area adjacent to the right heart border and the size of the opacity the same compared to his previous x rays. An Echocardiography was done and this showed moderate to severe impairment of left ventricular systolic function with an EF of 30-35%, mild to moderate mitral regurgitation and showed a cystic lesion anterior to the right ventricle. A CT chest was done for evaluation of the pericardial cyst and showed centrilobular emphysema and a mass in the rt lung abutting the right border of the heart with a maximum diameter of 8.7 cm. The patient was non-compliant to his medications and repeatedly missed his follow up appointments. He also continued to smoke despite progression of his COPD. The cause of his shortness of breath was likely due to progression of heart failure and COPD with the pericardial cyst probably has no or minimal rule. Conclusion Pericardial cysts are rarely symptomatic and usually has a benign course. We aimed at increasing awareness of this rare benign animally. Abstract P1829 Figure.

Cysts of the Mediastinum

Mediastinal cysts are fluid-filled lesions surrounded by a thin wall with an epithelial lining. These cysts are typically congenital, account for approximately 15-20% of all mediastinal masses, and may be found in any mediastinal compartment. Although mediastinal cysts may be initially detected on chest radiography, these lesions are optimally evaluated with computed tomography (CT) or magnetic resonance imaging (MRI). Cysts typically manifest as well-circumscribed, spherical lesions of water attenuation or signal, buy may appear heterogeneous when complicated by hemorrhage or infection. A focused differential diagnosis may be generated based on lesion location. For instance, bronchogenic cysts are most common in the middle mediastinum and pericardial cysts are typically found in the right cardiophrenic angle. Other mediastinal cysts include esophageal duplication and neurenteric cyst. Although meningocele is not a true cyst, it exhibits a cystic appearance on imaging.

Symptomatic Pericardial Cyst: An Atypical Case of Pleuritic Chest Pain

Pericardial cysts were first described in 1837 as diverticula extending from the pericardium. They are rare and frequently asymptomatic. Symptomatic presentations may be similar to more common causes of chest pain or dyspnea such as acute coronary syndrome or pulmonary embolism. Emergency physicians should consider mediastinal mass, and in this case pericardial cyst, in the differential diagnosis of chest pain because of the risk for tamponade, sudden cardiac death, or other life-threatening complications. Here, we describe a novel presentation of a pericardial cyst presenting as atypical chest pain.