1
|
Zhang WM, Maimaitiaili A, Aizezi R, Abulimiti K, Yan F, Huo Q. Surgical Management of Pericardial Cysts: A Single-Center Retrospective Study. Cureus 2023; 15:e49298. [PMID: 38957189 PMCID: PMC11218600 DOI: 10.7759/cureus.49298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 07/04/2024] Open
Abstract
Introduction Pericardial cysts (PCs) are infrequent, non-malignant, and congenital abnormalities. The identification and treatment of PCs remain a significant challenge, with limited research on surgical management. Methods We performed a retrospective study of patients with PCs who underwent surgical intervention at the First Affiliated Hospital of Xinjiang Medical University from February 2002 to December 2022. Results A total of 55 patients underwent surgery due to PCs during the study period. Thirty-one were females and 24 were males. The average age of the patients was 44.7 ± 12.9 (six to 63 years old). PCs were located in the right hemithorax in 50 (90.9%) patients and left hemithorax in five (9.1%) patients. Approach methods were video-assisted thoracoscopic surgery (VATS) in 43 (78.2%) cases; thoracotomy in 11 (20%) cases, and median sternotomy in one (1.8%) cases. The average postoperative hospitalization period was 5.6 days (two to 14 days). Three patients developed postoperative complications (two pleural effusion, one pneumonia), whereas no mortality was observed in any patient due to the operation. Forty-one patients (74.5%) were followed up for three months to eight years postoperatively, during which no recurrent cysts were detected. Conclusion In this single-center retrospective study, we demonstrated that pericardial cyst cure is an appropriate operation according to cyst characteristics. VATS has been shown to be highly effective and safe in patients with PCs, offering the advantage of reducing postoperative morbidity efficiently.
Collapse
Affiliation(s)
- Wei-Min Zhang
- Department of Cardiac Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, CHN
| | - Abdunabi Maimaitiaili
- Department of Cardiac Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, CHN
| | - Rehemutulajiang Aizezi
- Department of Cardiac Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, CHN
| | - Kadeyanmu Abulimiti
- Department of Cardiac Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, CHN
| | - Fei Yan
- Department of Cardiac Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, CHN
| | - Qiang Huo
- Department of Cardiac Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, CHN
| |
Collapse
|
2
|
Shirzadi R, Roshanzamir Z, Pak N, Rajabi R, Mohammadi F. An unusual site of a pericardial cyst in a child: A case report. Radiol Case Rep 2023; 18:1498-1501. [PMID: 36816338 PMCID: PMC9932291 DOI: 10.1016/j.radcr.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 02/05/2023] Open
Abstract
Pericardial cysts are rare congenital anomalies, often clinically silent and incidentally found on imaging. However, patients with pericardial cysts may present with chest pain, tachypnea, and, rarely, symptoms secondary to cardiac tamponade. Echocardiography (transthoracic or transesophageal) and chest computed tomography (CT) scan with contrast are diagnostic modalities of choice in patients with pericardial cysts. Conservative management is justified in asymptomatic patients, while a surgical approach is recommended in symptomatic patients. Here, we describe the case of a 12-year-old boy who underwent imaging during the coronavirus disease 2019 (COVID-19) pandemic and was incidentally found to have a pericardial cyst.
Collapse
Affiliation(s)
- Rohola Shirzadi
- Pediatric Respiratory and Sleep Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Roshanzamir
- Pediatric Respiratory and Sleep Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran,Pediatric Respiratory Center, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Neda Pak
- Department of Radiology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Fatemeh Mohammadi
- Tehran University of Medical Sciences, Tehran, Iran,Children's Medical Center, No 63, Gharib Ave, Keshavarz Blvd., Tehran, 14194, Iran,Corresponding author.
| |
Collapse
|
3
|
Qamar Y, Gulzar M, Qamar A, Sabry H, Minhas T. An Incidental Finding of a Large Pericardial Cyst. Cureus 2022; 14:e23917. [PMID: 35530868 PMCID: PMC9078146 DOI: 10.7759/cureus.23917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 12/02/2022] Open
Abstract
A pericardial cyst is a rare and benign cause of a mediastinal mass. They are frequently asymptomatic and are usually incidental findings on imaging. Symptoms may include persistent cough, atypical chest pain, dysphagia, and dyspnea. Diagnosis is usually established with the aid of imaging, including a chest x-ray, a computed tomography (CT) scan, and magnetic resonance imaging (MRI). Therapeutic options include surgical resection or aspiration for large and/or symptomatic cysts, whereas conservative management with routine follow-up is advised for small or asymptomatic cysts. We herein describe the case of a 48-year-old lady, who presented with clinical features suggestive of acute cholecystitis, with an incidental finding of a pericardial cyst, measuring approximately 10.1 cm x 8.7 cm x 10.7 cm. The patient underwent video-assisted thoracoscopic surgery (VATS) for excision of the pericardial cyst. She had an uneventful recovery and was discharged on the second post-operative day. At six months, there was no evidence of disease recurrence.
Collapse
|
4
|
Armstrong SM, Thavendiranathan P, Butany J. The pericardium and its diseases. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00021-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
|
5
|
Noori NM, Shafighi Shahri E, Soleimanzadeh Mousavi SH. Large Congenital Pericardial Cyst Presented by Palpitation and Left Ventricle Posterior Wall Compression: A Rare Case Report. Pediatr Rep 2021; 13:57-64. [PMID: 33467404 PMCID: PMC7839019 DOI: 10.3390/pediatric13010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/16/2020] [Indexed: 11/24/2022] Open
Abstract
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.
Collapse
|
6
|
Abstract
PURPOSE OF REVIEW This is an in-depth review on the etiology, clinical manifestation, differential diagnosis, diagnostic modalities, complications, and management of pericardial cysts (PCs). RECENT FINDINGS PCs are the third most common type of mediastinal masses and are usually identified incidentally by chest x-ray (CXR) or transthoracic echocardiography (TTE). Although most PCs are asymptomatic, they might lead to serious complications such as cardiac tamponade. Diagnosis is confirmed by cardiac computed tomography or cardiac magnetic resonance. Cysts need to be followed by imaging every 1 to 2 years; however, a recent report suggested less frequent follow-up. Most cases resolve spontaneously, but if needed, aspiration or surgical resection can be done. PCs are rare entities and are usually detected incidentally after CXR or TTE. Providers should be aware of this condition since it could potentially lead to serious complications.
Collapse
Affiliation(s)
- Mohamed Khayata
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Saqer Alkharabsheh
- Center for the Diagnosis and Treatment of Pericardial Disease, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Nishant P Shah
- Center for the Diagnosis and Treatment of Pericardial Disease, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Allan L Klein
- Center for the Diagnosis and Treatment of Pericardial Disease, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA.
| |
Collapse
|
7
|
Alkharabsheh S, Gentry Iii JL, Khayata M, Gupta N, Schoenhagen P, Flamm S, Murthy S, Klein AL. Clinical Features, Natural History, and Management of Pericardial Cysts. Am J Cardiol 2019; 123:159-163. [PMID: 30390989 DOI: 10.1016/j.amjcard.2018.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 09/18/2018] [Accepted: 09/21/2018] [Indexed: 11/20/2022]
Abstract
With the increased use of medical imaging, there has been an increase in the numbers of pericardial cysts identified. However, there is a paucity of data regarding the clinical course for pericardial cysts. Hence, we aimed to study the clinical features and natural history of pericardial cysts. We retrospectively studied all patients with the diagnosis of pericardial cysts based on computed tomography (CT) chest or cardiac magnetic resonance imaging (CMR) between 2008 and 2014. The maximum diameter of the cyst was measured at the initial study (CT/CMR) and was compared with the most recent follow-up imaging modality of the same type if available. A change in the maximum diameter more than 10% was considered significant. We included 103 patients in the study; 89% were asymptomatic and 67% were females. Twenty-nine asymptomatic patients had repeat imaging with the same modality (CT/CMR) with a mean follow-up of 23 months. The maximum cyst diameter decreased by a mean of 25% in 34% of the patients and increased by a mean of 13% in 17% of the patients. The remaining patients (48%) had no significant change. All 29 patients remained asymptomatic. In conclusion, most pericardial cyst cases were asymptomatic. On repeat imaging, approximately 1/3 of pericardial cysts were found to decrease in size, whereas interval enlargement was infrequent and unlikely to be clinically relevant. Therefore, within the limitations of our study, serial imaging in asymptomatic patients with CT or CMR does not appear to impact management decisions.
Collapse
Affiliation(s)
- Saqer Alkharabsheh
- Department of Cardiovascular Medicine, Center for the Diagnosis and Management of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - James L Gentry Iii
- Department of Cardiovascular Medicine, Center for the Diagnosis and Management of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Mohamed Khayata
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Neha Gupta
- Department of Cardiovascular Medicine, Center for the Diagnosis and Management of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Paul Schoenhagen
- Department of Radiology, The Cleveland Clinic Foundation, Cleveland, Ohio
| | - Scott Flamm
- Department of Cardiovascular Medicine, Center for the Diagnosis and Management of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sudish Murthy
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Allan L Klein
- Department of Cardiovascular Medicine, Center for the Diagnosis and Management of Pericardial Diseases, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
| |
Collapse
|
8
|
Large Pericardial Cyst Presenting as Acute Cough: A Rare Case Report. Case Rep Cardiol 2018; 2018:4796903. [PMID: 30627447 PMCID: PMC6305018 DOI: 10.1155/2018/4796903] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 11/21/2018] [Indexed: 11/18/2022] Open
Abstract
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.
Collapse
|
9
|
Robotic-assisted excision of a left ventricular thrombus. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013; 2:251-3. [PMID: 22437135 DOI: 10.1097/imi.0b013e31815cea73] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE : Left ventricular thrombus is a rare entity usually associated with myocardial infarction. The daVinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, Calif) offers excellent visualization of the mitral subvalvular apparatus and should provide an effective means to excise a left ventricular mass. METHODS : A 34-year-old man presented to an outside institution with fever of unknown origin and ulcerative colitis. As part of this workup, he underwent a transthoracic echocardiogram and subsequently a transesophageal echocardiogram that showed a 2-cm left ventricular apical pedunculated mass. He was referred to our institution for excision of this ventricular mass. Because of the pedunculated nature of the mass, he was deemed a candidate for a robotic-assisted minimally invasive approach. RESULTS : The patient underwent successful robotic-assisted excision of a left ventricular mass. Total robotic time was 15 minutes. Pathology revealed that the mass was a left ventricular thrombus. The patient experienced an uneventful recovery and was discharged home in 4 days. CONCLUSIONS : Left ventricular mass excision can be safely performed with the daVinci Surgical System. The daVinci Surgical System offers excellent visualization of the entire left ventricular cavity.
Collapse
|
10
|
Parra JL, Mears EA, Borde DJ, Levy MS. Pericardial effusion and cardiac tamponade caused by intrapericardial granulation tissue in a dog. J Vet Emerg Crit Care (San Antonio) 2009; 19:187-92. [PMID: 19691570 DOI: 10.1111/j.1476-4431.2009.00406.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe and report successful surgical management of pericardial effusion and cardiac tamponade in a dog caused by intrapericardial granulation tissue. CASE SUMMARY An 8-month-old, intact male, Greater Swiss Mountain Dog was referred for cardiac evaluation following 2 weeks of progressive lethargy, abdominal distention, and difficulty breathing. On the day of presentation, the dog had an episode of acute collapse. A 14-cm multilocular pericardial cystic lesion causing collapse of the right atrial free wall and resulting in pericardial tamponade was observed on echocardiogram. After the dog subsequently experienced two acute episodes of pericardial effusion, a subtotal pericardectomy was performed and clinical signs resolved. The histopathologic diagnosis of the mass was inflammation and granulation tissue, likely caused by a resolving hematoma or abscess. NEW OR UNIQUE INFORMATION PROVIDED This is the first report of intrapericardial granulation tissue as the cause of pericardial effusion and cardiac tamponade.
Collapse
Affiliation(s)
- Joshua L Parra
- Florida Veterinary Referral Center and 24-Hour Emergency and Critical Care, Estero, FL 33928, USA.
| | | | | | | |
Collapse
|
11
|
Lutz CJ, Bhamidipati CM, Ford B, Swartz M, Hauser M, Kyobe M, Dilip K. Robotic-Assisted Excision of a Left Ventricular Thrombus. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2007. [DOI: 10.1177/155698450700200506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Brant Ford
- Department of Surgery, Division of Cardiothoracic Surgery
| | - Mike Swartz
- Department of Surgery, Division of Cardiothoracic Surgery
| | - Michael Hauser
- Department of Anesthesia, State University of New York Upstate Medical University, Syracuse, New York
| | - Moses Kyobe
- Department of Cardiology, Oswego Hospital, Oswego, New York
| | | |
Collapse
|
12
|
Bernasconi A, Yoo SJ, Golding F, Langer JC, Jaeggi ET. Etiology and outcome of prenatally detected paracardial cystic lesions: a case series and review of the literature. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2007; 29:388-94. [PMID: 17357182 DOI: 10.1002/uog.3963] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
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.
Collapse
Affiliation(s)
- A Bernasconi
- Fetal Cardiac Program, Department of Pediatrics, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | |
Collapse
|
13
|
Portillo-Carroz K, Miguel-Campos E, Montoliú Tarramera R. [Pericardial cyst: all's well that ends well]. Rev Esp Cardiol 2007; 59:1082-3. [PMID: 17125722 DOI: 10.1157/13093990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
14
|
Peters PJ, Reinhardt S. The Echocardiographic Evaluation of Intracardiac Masses: A Review. J Am Soc Echocardiogr 2006; 19:230-40. [PMID: 16455432 DOI: 10.1016/j.echo.2005.10.015] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2005] [Indexed: 11/28/2022]
Abstract
Echocardiography is an invaluable procedure for the evaluation of intracardiac masses, and can reliably identify mass location, attachment, shape, size, and mobility, while defining the presence and extent of any consequent hemodynamic derangement. With careful attention to mass location and morphology, and appropriate application of clinical information, echocardiography can usually distinguish between the 3 principal intracardiac masses: tumor, thrombus, and vegetation. Transesophageal imaging frequently adds additional important information to the assessment of mass lesions and should always be considered when image quality is inadequate or pertinent clinical questions remain unanswered with surface imaging. This review will focus on primary and metastatic tumors of the heart.
Collapse
|
15
|
Frans EE, Nanda NC, Patel V, Vengala S, Mehmood F, Fonbah WS, Bodiwala K. Transesophageal Two-Dimensional Echocardiographic Identification of Hiatal Hernia. Echocardiography 2005; 22:533-5. [PMID: 15966940 DOI: 10.1111/j.1540-8175.2005.50017.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We report a case of a middle-aged woman in whom a transesophageal echocardiogram showed a mass-like lesion posteriorly near the descending thoracic aorta. We were able to make a definitive diagnosis of this mass as a hiatal hernia because of a thick inner lining measuring 6-9 mm in thickness similar to the stomach mucosa, and the presence of a few microbubbles within the mass. In addition, the microbubbles increased considerably after 10 cc of agitated normal saline flush via a nasogastric tube.
Collapse
Affiliation(s)
- Ebenezer E Frans
- Division of Cardiovascular Diseases, University of Alabama at Birmingham, Birmingham, AL 35249, USA
| | | | | | | | | | | | | |
Collapse
|