A large pericardial cyst mimicking a unilateral pleural effusion: A case report

Abstract

Rationale: Pericardial cysts are a rare benign disorder with a variable clinical presentation depending on their size and location. The diagnosis of pericardial cysts is usually based on imaging examinations. The definitive treatment is surgical resection. Patient concern: A 36-year-old woman presented with progressive left-sided chest pain and exertional dyspnea, with symptoms resembling pleural effusion. Diagnoses: The patient was diagnosed with a pericardial cyst based on imaging and video-assisted thoracoscopic surgery (VATS). Intervention: VATS was performed. Outcomes: The patient’s symptoms improved after successful removal of the pericardial cyst. Follow-up chest computed tomography exhibited no evidence of recurrence. Lessons: Clinicians should include pericardial cysts in the differential diagnosis of pseudopleural effusion. VATS is a feasible and safe method to treat symptomatic and large pericardial cysts.

Large Pericardial Cyst Mimicking Recurrent Unilateral Pleural Effusion on CT Scan: A Case Report and Literature Review

“…A follow-up chest CT performed six months after discharge showed no evidence of recurrence. Based on this case, the study suggests that VATS is a feasible and safe method for treating symptomatic and large PCs [8]. Although PCs typically have a benign course, complications have been reported, including cyst rupture, erosion into adjacent structures like the right ventricular wall or superior vena cava, cardiac tamponade, mitral valve prolapse, obstruction of the right mainstem bronchus, atrial fibrillation, and even sudden death [6].…”

“…Inflammation can play a role in their formation, such as in cases of rheumatic pericarditis, bacterial infections (especially tuberculosis), and echinococcosis [7]. Additionally, PCs can develop due to trauma, complications arising from cardiac surgery, or as a complication of chronic hemodialysis [8]. These various etiologies highlight that PCs can arise from different underlying factors beyond the congenital origin, and a comprehensive evaluation is necessary to determine the specific cause in each case.…”

“…Therefore, histological examination through biopsy or surgical resection is often necessary to obtain a definitive diagnosis and confirm the nature of the cyst. The histological examination provides a consolidated diagnosis by examining the tissue samples, allowing for a comprehensive assessment and accurate characterization of the PC [8].…”

“…Despite the restricted access to the thorax, VATS still provides adequate visualization, making it a viable option for patients with debilitated health or marginal pulmonary reserve. This less invasive approach offers an effective alternative for performing thoracic surgeries, reducing surgical trauma and potential complications, particularly in high-risk patients [2,8].…”

“…In many patients, close monitoring with serial transthoracic echocardiography is sufficient to ensure a benign course and allow for potential spontaneous resolution of the PC. If intervention is necessary, treatment options include percutaneous aspiration, surgical intervention using VATS, or surgical excision [8][9][10]14]. Percutaneous aspiration is a minimally invasive approach that can be attempted for diagnostic purposes and therapeutic relief of symptoms.…”