Acute right-sided heart failure due to hemorrhage into a pericardial cyst

Chronic unrelenting cough secondary to pericardial cyst impingement of right phrenic nerve

Located in the mediastinum, pericardial cysts are rare and benign congenital abnormalities commonly identified as incidental findings on imaging. However, some patients with abnormally enlarged cysts present with compressive symptoms, which include recurrent infections, tamponade from cardiac compression and respiratory complications. Our report highlights a challenging case of a patient with recurrent respiratory symptoms secondary to phrenic nerve compression. Misdiagnosis over the past decade resulted in ineffective interventions. After clear identification of the cyst compression of the ipsilateral phrenic nerve, the patient underwent a minimally invasive robotically assisted cyst resection with phrenic nerve preservation that alleviated respiratory symptoms.

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.

Massive intrapericardial cyst: A rare cause of chronic cough

We present a unique case of massive intrapericardial cyst manifesting as chronic cough, which highlights the unique presentation of this rare condition. Although uncommon, intrapericardial cyst should be considered in cases of chronic, non-productive cough, especially in the absence of lung pathology. The role of multi-modality imaging remains essential for early detection of the condition and monitoring for potential complications.

Anesthetic and surgical considerations of giant pericardial cyst: Case report and literature review

Introduction

Pericardial cysts are considered as a rare congenital abnormality, mostly found incidentally. The estimated incidence of pericardial cyst is 1:100,000 and represent approximately 6% of all mediastinal masses. Patients can present with symptoms similar to acute chest pain or right-sided heart failure or can be asymptomatic.

Presentation

A 46-year-old female who is known to have hypertension and hypothyroidism presented to the breast clinic with left breast mass that was proved by core needle biopsy as proliferative breast lesion. During the preoperative assessment, the patient reported progressive shortness of breath and cough over the last two years and bilateral lower limb edema. Her preoperative chest X-ray showed a well-defined oval like opacification at the right cardiophrenic angle that was proved by chest computed tomography imaging as a cystic mass od most likely a pericardial origin. A huge pericardial cyst originating from the right diaphragmatic surface was excised through a mini-sternotomy incision with smooth postoperative recovery. The patient-reported significant improvement in her symptoms and her lifestyle during her follow up.

Discussion

Pericardial cysts represent 6%-7% of all mediastinal masses with an estimated incidence of 1:100,000. About 70% of pericardial cysts originate at the right cardiophrenic angle and less frequently at the left cardiophrenic angle, they are usually suspected when the chest x-ray shows an enlarged contour of the right heart border. Mediastinal cysts have many differential diagnoses and the preoperative decision might be challenging in many cases. Pericardial cysts appear as oval, thin-walled homogeneous masses on cardiac computed tomography. The choice between surgical intervention and conservative follow up is related mainly to the size and symptoms that are induced by the cyst.

Conclusion

As pericardial cysts are rarely diagnosed pathology, a high index of suspicion is essential for diagnosis. Surgical resection is indicated when they are huge, enlarging in size or symptomatic. Morbidity and mortality risks following pericardial cyst excision are very low.

Video-Assisted Thoracoscopic Treatment of Coelomic Cysts

Background: Coelomic cysts are uncommon benign cyctic lesions of the mediastinum. Complete resection of the cyst with surgical treatment is indicated depending on whether the patient is symptomatic or whether the cyst grows during follow-up, or whether the diagnosis is uncertain. Surgical treatment prevents complications, relieves symptoms, and establishes diagnosis. Video-assisted thoracoscopic surgery (VATS) is the best method for excision of these cysts. This approach is safe and effective, has low morbidity, and shortens the length of hospital stay Objectives: We aimed to analyze our experience with coelomic cysts through VATS, reviewing clinical, radiological, and pathological features, early and long-term results of surgical management. Patients and Methods: Between January 2011 and December 2018, 20 patients with coelomic cysts who underwent VATS at our clinic were included in the study. Results: The study included 11 female and 9 male patients with a mean age of 45.6 years. Symptoms were present in 17 patients and 3 were asymptomatic. The average cyst diameter was 5.4 cm (range 2-8 cm). Fourteen of them were right sided, the others were left sided. There were no operative mortality and complications. Postoperatively there were no complications, in all cases course was uneventful, all of them were discharged after a mean of 3 days (range 2-6 days). Conclusions: Considering the low complication rate and hospital stay, excision of coelomic cysts through VATS is extremely safe and comfortable, so it should be considered the primary therapeutic procedure.

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.

Hemorrhagic Pericardial Cyst Complicated with Constrictive Pericarditis

Pericardial cysts are rare abnormalities and are usually asymptomatic. Although several case reports on their diagnosis and treatment have been published, those on hemorrhagic pericardial cysts remain limited. We herein report the case of a 70-year-old man with a hemorrhagic pericardial cyst complicated with constrictive pericarditis 2 years after the initial diagnosis.

Large Pericardial Cyst Presenting as Acute Cough: A Rare Case Report

Pericardial cysts are an uncommon cause of mediastinal masses and may be found incidentally on imaging. Symptoms commonly include cough, chest pain, and shortness of breath elucidating a broad differential on examination. Diagnosis is predominantly made using imaging modalities, such as CT, MRI, and CXR with treatment including resection for symptomatic cysts and observation for asymptomatic cysts. Due to a lack of specific signs and symptoms towards identifying pericardial cysts, many are identified at a later stage requiring resection by video-assisted thoracoscopic surgery (VATS). We present the rare case of a patient presenting with a sudden onset cough, shortness of breath, and pleuritic chest pain found to have a large pericardial cyst.

Pericardial Cyst: Cause of Sudden Cardiac Death?

Cardiovascular disease is the leading cause of sudden death in the world. The etiology of sudden cardiac death involves a wide range of diseases, but seldom pericardial cysts. A pericardial cyst is an uncommon cyst usually located in the middle mediastinum and rarely in the posterior part. They are usually harmless and asymptomatic. Here, we present a case of a 63-year-old woman who presented with dyspnea and hoarseness, but died suddenly after a CT scan was attempted. The detailed forensic pathologic and histologic examination revealed a pericardial cyst located in the posterior mediastinum. Toxicology and biochemistry tests, including tryptase, found no competing cause of death.

Neoplastic Pericardial Disease

Pericardial tumors are rare lesions that include a range of neoplastic conditions that may arise within the pericardium or metastasize to involve it secondarily. Understanding the spectrum of lesions that are included in the differential diagnosis of a pericardial mass-lesion is critical to making timely, accurate diagnoses and getting the appropriate therapy should one be necessary. This review summarizes the radiologic and pathologic findings of the most commonly encountered of these entities.

What Ultrasounds, Sometimes, Cannot See: A Case of Posterior Pericardial Cyst

Pericardial cysts (PCs) are very rare, often congenital, mediastinal masses. Usually, they are located in the right cardiophrenic angle and only in 8% of cases in the anterior or posterior mediastinum. Computed tomography and/or magnetic resonance imaging are accurate tools for the diagnosis and characterization of mediastinal masses. However, echocardiography is, in many cases, a good screening technique. If asymptomatic, they do not require surgical excision. The authors describe a case of posterior mediastinum PC; in these cases, echocardiography cannot see the mass and three-dimensional imaging techniques are required. The clinical management of this case is discussed.

Current concepts of diagnosis and management of pericardial cysts

Pericardial cysts are rare with an incidence of about 1 in every 100,000 persons and one in 10 pericardial cysts may actually be a pericardial diverticulum. Pericardial cysts and diverticula share similar developmental origin and may appear as an incidental finding in chest roentgenogram in an asymptomatic patient. CT scan is considered as best modality for diagnosis and delineation of the surrounding anatomy. Cardiac MRI is recommended in the evaluation of the compressive effects caused by the pericardial cysts. The authors recommend echocardiography for serial follow up and image guided aspiration of the pericardial cyst in presence of compressive effects leading to cardiovascular and airway symptoms. A systematic approach is desirable for management of pericardial cysts depending on size, shape and compression effects, symptoms and easy access to serial Echocardiographic follow up. However, pericardial diverticulum may not be differentiated from cysts by the above testing, and only identified at surgery.

Video-assisted and minimally-invasive open chest surgery for the treatment of mediastinal tumors and masses

This article reviews the anatomy of the mediastinum as well as indications, limitations, techniques, and results of video-assisted thoracic surgery (VATS) and other minimally-invasive open-chest surgery approaches currently used for the surgical management of mediastinal tumors and masses. It is written by two surgeons with vastly different backgrounds and thoracic surgical experience. One of them is young and very familiar with VATS approaches and technologies while the other is a senior surgeon relatively unfamiliar with minimally-invasive techniques. This combination of authorship is ideal to analyze the pros and cons of the use of minimally-invasive approaches for the surgical management of mediastinal lesions such as thymic epithelial tumors (TETs) or neurogenic tumors. This is important because several thoracic surgeons have expressed concerns about the ability of thoracoscopic procedures to maintain adherence to sound oncological principles.

Pericardial Masses, Cysts and Diverticula: A Comprehensive Review Using Multimodality Imaging

Pericardial masses/tumors, cysts, and diverticula are quite rare. Presentation is variable and often patients may be asymptomatic with pericardial involvement initially only detected at time of autopsy. When patients do present with symptoms they are often non-specific and often mimic other conditions of the pericardium such as pericarditis, pericardial effusion, constriction or tamponade. Therefore, echocardiography and cross-sectional imaging are essential in identifying and characterizing pericardial disease. Imaging findings vary in specificity depending on the type of tumor. The purpose of this review is to describe the role of multi-modality imaging and characteristic findings in patients with pericardial masses/tumors, cysts, and diverticula.

Imaging of an atypical pericardial cyst

Pericardial cysts are uncommon mediastinal lesions that are usually congenital in origin. Patients are usually asymptomatic and the cysts are generally discovered on routine radiography for unrelated purposes. This case illustrates a symptomatic presentation of a haemorrhagic pericardial cyst in which radiographic, echocardiographic and multislice (MRI and CT) imaging were performed. The imaging findings were not typical of pericardial cysts leading to a diagnostic quandary despite the varied imaging techniques. In conclusion, it is important to appreciate that the imaging findings of pericardial cysts can be varied. Radiologists and clinicians alike should be aware of this variability.

Diagnosis of pericardial cysts using diffusion weighted magnetic resonance imaging: A case series

Introduction

Congenital pericardial cysts are benign lesions that arise from the pericardium during embryonic development. The diagnosis is based on typical imaging features, but atypical locations and signal magnetic resonance imaging sequences make it difficult to exclude other lesions. Diffusion-weighted magnetic resonance imaging is a novel method that can be used to differentiate tissues based on their restriction to proton diffusion. Its use in differentiating pericardial cysts from other pericardial lesions has not yet been described.

Case presentation

We present three cases (a 51-year-old Caucasian woman, a 66-year-old Caucasian woman and a 77-year-old Caucasian woman) with pericardial cysts evaluated with diffusion-weighted imaging using cardiac magnetic resonance imaging. Each lesion demonstrated a high apparent diffusion coefficient similar to that of free water.

Conclusion

This case series is the first attempt to investigate the utility of diffusion-weighted magnetic resonance imaging in the assessment of pericardial cysts. Diffusion-weighted imaging may be a useful noninvasive diagnostic tool for pericardial cysts when conventional imaging findings are inconclusive.

A huge mediastinal organizing hematoma causing reversal of atrial septal defect shunt flow

We report a case of a 46-year-old woman who presented with subacute exertional dyspnea and severe hypoxia. A large cystic mass compressing the right side of the heart along with right-to-left atrial shunt flow through an alleged atrial septal defect (ASD) were detected on echocardiography. CT scan of the chest and MRI of the heart revealed a loculated cystic mediastinal mass with hemorrhage measuring 5.5×8 cm compressing the right atrium and ventricle. The patient underwent cyst resection and primary closure of the ASD. This report illustrates a case of an unusual symptomatic pericardial mass compressing the right atrium and ventricle in a patient with an secundum ASD.

Multimodality imaging of pericardial diseases

Pericardial disease is an important cause of morbidity and mortality in patients with cardiovascular disease. Inflammatory diseases of the pericardium constitute a spectrum ranging from acute pericarditis to chronic constrictive pericarditis. Other important entities that involve the pericardium include benign and malignant pericardial masses, pericardial cysts, and diverticula, as well as congenital absence of the pericardium. Recent advances in multimodality noninvasive cardiac imaging have solidified its role in the management of patients with suspected pericardial disease. The physiologic and structural information obtained from transthoracic echocardiography and the anatomic detail provided by cardiac computed tomography and magnetic resonance have led to growing interest in the complementary use of these techniques. Optimal management of the patient with suspected pericardial disease requires familiarity with the key imaging modalities and the ability to choose the appropriate imaging tests for each patient. This report reviews the imaging modalities most useful in the assessment of patients with pericardial disease, with an emphasis on the complementary value of multimodality cardiac imaging.

Hemorrhage into a pericardial cyst and associated right ventricular compression after blunt chest trauma

Hemorrhage into a pericardial cyst is an extremely rare event after blunt chest injury and may lead to compression of cardiac chambers. Most pericardial cysts develop adjacent to the sternum, at the right or left cardiophrenic angle; therefore a direct blow to the chest may be associated with hemorrhage into a pericardial cyst. Surgical resection is reasonable because hemorrhagic content of cysts may cause failure of percutaneous interventions. The authors present the case of 20-year-old man with a giant hemorrhagic pericardial cyst diagnosed after blunt chest injury, which caused isolated compression of the right ventricle and demonstrates clinical features of this rare pathology.

[Benign primary cystic lesions of mediastinum in adult: the clinical spectrum and surgical treatment]

BACKGROUND AND OBJECTIVE

The mediastinal cysts form a group of heterogeneous and uncommon benign lesions of neoplastic, congenital, or inflammatory conditions. The forgoing controversy is how to manage them; surgical removal or observation. We reviewed our experience including some rare conditions, emphasizing the clinical spectrum and surgical treatment. PATIENTES AND METHODS: This is a retrospective review between 2000 and 2007 included 34 cases of primary mediastinal cystic lesions. Clinical features, imaging techniques, surgical operation, morbidity, mortality and follow-up were analyzed.

RESULTS

There were 18 females (53%) and 16 males (47%), with a mean age+/-standard deviation of 45.3+/-14.1 years (range: 22-74). Most of cysts were congenital (94%), except patients with hydatid disease (6%). 24% of cysts (n=8) were detected in anterior mediastinum. Rest of them (n=26) were located in visceral mediastinum. Patients usually were symptomatic (61%). Chest pain and discomfort was most common symptom, others were dyspnea, cough and hemoptysis, respectively. Cysts excision was performed in all cases with an uneventful recovery and with no recurrence in long term follow up.

CONCLUSIONS

Asymptomatic mediastinal cysts are not rare. Surgery is a reliable method of treatment of mediastinal cysts with acceptable mortality and morbidity.

Pericardial cyst: an unusual cause of pneumonia

Introduction

Pericardial cysts occur rarely with an incidence rate of 1 per 100,000. They are usually detected by chance and are clinically silent in most cases.

Case presentation

We report the case of a 66 year old Irish male, with signs and symptoms of pneumonia. A chest X-Ray confirmed left lower lobe consolidation. Further imaging including a CT thorax identified a large pericardial cyst as the cause of the symptoms.

Conclusion

Although pericardial cysts are usually asymptomatic, they can present with chest pain and symptoms of respiratory tract infection.

Acute Cardiac Tamponade Due to a Bleeding Pericardial Cyst in a 3-Year-Old Child

We report a case of a pericardial cyst complicated with acute cardiac tamponade in a 3-year-old child with no previous cardiac history who was transferred to our university hospital because of hemodynamic shock. A chest roentgenogram revealed marked cardiac enlargement, and transthoracic echocardiography showed massive pericardial effusion with a moving cystic structure. Percutaneous needle aspiration yielded bloody pericardial fluid. Emergency drainage of the pericardial effusion and resection of the cyst were performed through a median sternotomy. We found a blood-containing cyst that was attached to the right atrium near the sinus node and to the inferior wall of the pericardial cavity.

Etiology and outcome of prenatally detected paracardial cystic lesions: a case series and review of the literature

OBJECTIVES

Isolated paracardial cysts, defined as cystic structures adjacent to or originating from the heart, are rare and etiologically heterogeneous congenital abnormalities. The purpose of this study was to review our experience with prenatally diagnosed isolated cysts.

METHODS

We reviewed retrospectively the medical charts and ultrasound records of all cases with an antenatal diagnosis of paracardial cyst at our institution between 2001 and 2006. Where applicable, the diagnosis was further substantiated by other imaging modalities and pathology.

RESULTS

The cysts in six fetuses were diagnosed at a median gestation of 20 (range, 19-38) weeks. Three of these fetuses presented with a fluid-filled cyst attached to or within the pericardial space (pericardial cysts), which resolved spontaneously by the time of delivery. In contrast, the cysts did not change in size or shape in the remaining three fetuses. Postnatal examination of the persistent cysts revealed three different etiologies: (1) a microcystic lymphangioma, located in the anterior mediastinum; (2) an isolated neurenteric cyst; and (3) a single bronchogenic cyst, both within the posterior mediastinum. The lymphangioma and neurenteric cyst were removed surgically after birth.

CONCLUSIONS

Fetal echocardiography enables early detection of paracardial cyst. Pericardial cysts disappeared spontaneously during the course of gestation without signs of fetal cardiac compromise, suggesting a benign prognosis. Imaging by magnetic resonance and computerized tomography were particularly useful to clarify the etiology, structure and extent of those cysts that had not resolved by the time of birth. Published by John Wiley & Sons, Ltd.

Diagnosis of pericardial cysts: Significance of cardiac magnetic resonance and literature review

Pericardial cysts are uncommon and caused by an incomplete coalescence of fetal lacunae forming the pericardium. The paper presents two cases of pericardial cyst and literature review. The first is a case of a female patient with progressive dispnoa and spherical mass located in the right cardiophrenic angle on a chest x-ray. A pericardial cyst with low signal intensity was noted on T1w, high signal intensity on T2w in TSE (turbo spin echo) sequence on magnetic resonance images (MRI) which was suggestive of serous content. The patient underwent pericardial puncture and was thereafter free of symptoms. Histological study of the cyst confirmed hydatid cyst diagnosis. Another patient is with echocardiographic evidence of cystic formation which was confirmed on MRI, with high signal intensity on SSFP (steady state free precession) sequence. The cyst was without septa and without communication with pericardial space. Since there were no significant hemodynamic changes, the patient is on regular follow up.

Thoracic radiculopathy from a paravertebral mesothelial cyst

We report on an extremely rare case of a paravertebral thoracic mesothelial cyst in a young woman who presented with dorsal radiculopathy affecting the T5 dermatome. The patient underwent a standard transthoracic intercostal approach with removal of the cyst. During the operation, the T5 intercostal neurovascular bundle was found firmly attached to the lesion elucidating the origin of the radicular pain. To our knowledge, this is the first report of radiculopathy due to a paravertebral mesothelial cyst. Although highly unusual, paravertebral mesothelial cyst should be considered in the differential diagnosis for lesions inducing dorsal radicular pain.

Cardiac varix in relation to right atrial free wall presenting as a mass compressing the right atrium and mimicking a pericardial cyst

Cardiac varix is a rare entity. It is generally small and is in relation to the interatrial septum, often mistaken as cardiac myxoma. A 19-year-old girl, on evaluation of respiratory infection, was found to have a mass compressing the right atrium. Computed tomographic scan and magnetic resonance imaging suggested a differential diagnosis of pericardial cyst or hydatid cyst. Peroperatively, a large (8 x 6.5 x 5.5 cm) cystic lesion in relation to the right atrial free wall was found. The histopathology of the resected mass revealed it to be a cardiac varix. The case is notable for its large size and its location in relation to the right atrial free wall.

Pericardial cysts in children: surgical or conservative approach?

The authors present a case of an 11-year-old boy with a history of mild asthma and cough who underwent radiographic examination of the chest. The radiograph showed a round, discrete mass in the right cardiophrenic angle. The patient underwent thoracoscopic excision, and histologic examination found a unilocular, pericardial cyst. The possible causes of mediastinal masses and an argument for their surgical removal is presented.

An unusual cause of chest pain

Pericardial cysts are rare mediastinal cysts, which are commonly asymptomatic. We report the case of a middle-aged lady, with a previous short history of chest pain, who was found to have a focal pericardial density, felt to have been a consequence of haemorrhage into such a cyst.

Thoracoscopic resection of unusual symptomatic pericardial cysts

Pericardial cysts are mediastinal tumors that usually have a benign course. Diagnostic and therapeutic thoracoscopy are warranted for suspect mediastinal masses, unsuccessful nondiagnostic less invasive procedures, and symptomatic unusually located pericardial cysts. We report a case of thoracoscopic resection of symptomatic pericardial cysts.

Value of transesophageal echocardiography in the diagnosis of compressive, atypically located pericardial cysts

Pericardial cysts are not common and rarely cause symptoms. We report 2 cases of atypically located pericardial cysts with hemodynamic compromise because of the direct compression of the pulmonary veins and the right pulmonary artery. In the first case, transesophageal echocardiography (TEE) disclosed a round cystic mass compressing the posterior wall of the right pulmonary artery, with blood flow reduction in the right lung. Because of the symptoms, the pericardial cyst was drained and the patient had an uneventful 1-year follow-up. In the second case, a large cystic mass compressing the left atrium and the pulmonary vein outflow was clearly shown by TEE in a patient with severe respiratory distress, cyanosis, and low blood pressure. A left ventricular thoracotomy was performed with the drainage of 500 mL serous fluid from the cyst.