Congenital pleuropericardial cysts

Myocardial infarction revealing a pleuropericardial cyst: a case report

Pericardial cysts are a rare entity, accounting for 6-7 percent of all mediastinal masses. They are frequently congenital relating to a failure of fusion of mesenchymal layers forming the pericardial space. Pericardial cysts are considered rare incidental findings, they are mostly asymptomatic and benign, however life-threatening complications may occur. Here we present a case of a silent pericardial cyst that was discovered by chance while performing transthoracic echocardiography (TTE) for a man who was admitted for myocardial infarction.

Review of pericardial disease on computed tomography

Echocardiography has long been the mainstay in the evaluation of cardiac and pericardial disease. As computed tomography (CT) has advanced, it has become a valuable partner in the imaging of the pericardium. The advantages of CT include a larger field of view, multiplanar reconstruction and increased discrimination between various soft tissues and fluids. CT is less operator dependent and can more easily, and reproducibly, image areas of the pericardium for which echocardiography has poor windows such as the right pericardium. The introduction of EKG gating has decreased cardiac motion artifact and can allow functional evaluation although echocardiography remains the primary source of real-time imaging of cardiac and valve motion. It is essential for the skilled cardiac imager to understand the strengths and weaknesses of CT and its role in the definition and assessment of pericardial disease.

Benign lesions of the mediastinum: A review with emphasis on cytology and small biopsy specimens

This review focuses on the diagnosis of select benign processes, ranging from reactive entities to heterotopic tissues to neoplasms, which may occur in the mediastinum. Currently, the mediastinum can be evaluated and biopsied with endoscopic procedures. Therefore, cytopathology specimens, fine needle aspirations, and small biopsies play an important role in the diagnosis of these lesions. In this review, an emphasis is given to relevant clinical presentations, histologic and cytologic findings, differential diagnoses, ancillary testing, and interpretation. Pitfalls are reviewed and discussed in each section. It is important for both surgical pathologists and cytopathologists to be familiar with these entities and their cytologic and histologic features that may be helpful in reaching a diagnosis.

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.

Pericardial Cysts: a Contemporary Comprehensive Review

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.

Clinical Features, Natural History, and Management of Pericardial Cysts

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.

Left Pleuropericardial Cyst

Introduction: Cysts of the mediastinum, which are benign masses, are usually detected by chance, and constitute a small but important diagnose group, representing 7 to 18% of all primary mediastinal tumors. Pleuropericardial cysts, located most frequently in the left anterior and inferior mediastinum, are identified in the fourth or fifth decade of life affecting females more than males with a sex ratio of 8:4. Material and method: We present the case of a 52 year old woman diagnosed with pericardial cyst located in the left cardiophrenic angle. CPP was rather big and was initially diagnosed as encysted pleurisy. Ultrasound guided exploratory thoracentesis was performed evacuating 300 ml “water spring” like fluid very scarce in cells. We further investigated our patient for differential diagnosis but the patient refused surgery and she is now managed conservatively with a close follow-up. Conclusions: A pericardial cyst should always be suspected when a cystic lesion is detected in the mediastinum. Pleuropericardial cysts are usually suspected after an abnormal chest X-ray is obtained. If the patient is asymptomatic and the information provided by CT indicates a benign tumoral process suggestive for a pleuropericardial cyst, conservative management with careful follow-up is justified.

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.

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.

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.

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.

Successful resection of an epicardial cyst

Cases of pericardial cyst have been reported by many authors, but the incidence of epicardial cyst originating directly from the epicardium in the pericardial cavity is extremely rare. A case of successful resection of epicardial cyst fortuitously discovered and diagnosed during cardiac operation is presented.

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.

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

This is a description of a rare complication of a pericardial cyst with spontaneous internal hemorrhage and following tamponade. The noninvasive diagnosis was done by transesophageal echocardiography and computed thoracic tomography. The cyst was thoracoscopically removed and pathologically examined. This case demonstrates a rare but important and life-threatening complication of mostly asymptomatic pericardial cysts.

Enlarging, atypically located pericardial cyst. Recent experience and literature review

Pericardial cysts frequently are recognized when they present in a cardiophrenic angle, but may not be suspected when they occur elsewhere in the chest. To highlight the unusual presentations of pericardial cysts, we present two patients with cysts in the upper mediastinum and review the reported experience with similar lesions. Our patients' cysts are particularly instructive because one cyst enlarged over 23 months and because the other did not appear cystic on a computerized tomographic scan. Because percutaneous aspiration may be an attractive alternative to surgical resection when a pericardial cyst is suspected, clinicians should include pericardial cyst in the differential diagnosis of upper mediastinal masses.

The differential diagnosis of paracardiac lesions: pericardial cysts

The differential diagnosis of paracardiac lesions includes pericardial cysts (PC), which are benign, developmental lesions. Patients with PC are usually asymptomatic, although chest pain or dyspnea may occur. The diagnosis may be established by chest roentgenogram (radiographic contour and location), fluoroscopy (changes in shape with respiration or positioning the patient), and echography (smooth, cystic contour and characteristic location). We present the diagnostic approach to patients with PC, and a review of the case histories of 12 patients with PC. Two symptomatic patients with PC were treated with surgical excision. Cyst aspiration in two patients yielded clear fluid and was initially considered therapeutic, but was followed by gradual reaccumulation of fluid. Six of ten asymptomatic patients followed for three to ten years did not develop symptoms, nor was there radiographic evidence of progressive PC enlargement. Three of ten died from unrelated causes during the follow-up period. Although symptomatic patients with PC may require surgical excision, asymptomatic patients with PC should be managed conservatively.

Massive pericardial coelomic cyst. Diagnostic features and unusual presentation

Pericardial coelomic cysts are uncommon tumors that are usually detected on a routine roentgenogram of the chest in an asymptomatic individual. Findings from physical examination are usually unremarkable. Needle aspiration, after echocardiographic finding of a cyst, may be diagnostic and therapeutic. Surgery may be indicated to exclude neoplasm or vascular abnormality. This case reort presents the largest coelomic cyst yet described. Ultrasonic studies were useful in the correct preoperative diagnosis, and surgical excision relieved the patient's symptoms.

Epicardial cyst--a case report

The first successful removal of an epicardial cyst is reported. Evidence is presented to demonstrate that the cyst developed as a result of an abnormality occurring within the first five weeks of fetal life.