An uncommon pericardial cyst in the central mediastinum: Incremental diagnosis with contrast-enhanced three-dimensional transesophageal echocardiography

Abstract

We report a case of a 76-year-old man, with the occasional finding of a mediastinal cyst because of subtle chronic dysphagia associated to sore throat, belching, and dysphonia. The paraesophageal cyst in the central mediastinum was studied with computed tomography (CT) scan and transesophageal three-dimensional (3D) echocardiography with contrast echo. In order to clarify doubts about localization (intra- versus extrapericardial) of the mediastinal cystic lesion the 3D transesophageal echocardiography (TEE) confirmed the presence of a large round cystic mass located contiguous to the esophagus, the left atrium and the aortic root/pulmonary trunk (located at the front of the lesion), as well as located intrapericardial. The cystic mass showed no blood flow at color Doppler mode and at ultrasound contrast echo with SonoVue agent. Due to the paucity of symptoms and to the definite imaging information of this intrapericardial cyst of nonvascular nature, due to pericardial cyst in an extremely unusual location, surgery was not performed. At follow-up of 1 month echocardiogram and 3 month CT scan the cyst appeared unchanged in dimensions.

Cysts Around the Heart: Differential Diagnosis and Multimodality Imaging Strategies for Paracardiac Cysts

“…Pericardial cysts are congenital lesions that occur due to incomplete fusion of the mesenchymal lacunae that form the pericardium during fetal development. 4 , 5 Their estimated prevalence is 1 in 100,000 people, and they are usually found in the right anterior cardiophrenic angle. 4 , 6 They are often incidentally identified on chest radiography and appear as an enlarged contour of the right heart border but may alter other cardiac borders as well.…”

“… 4 , 5 Their estimated prevalence is 1 in 100,000 people, and they are usually found in the right anterior cardiophrenic angle. 4 , 6 They are often incidentally identified on chest radiography and appear as an enlarged contour of the right heart border but may alter other cardiac borders as well. 5 , 6 , 7 Sometimes pericardial cysts resolve spontaneously, although, similar to the other paracardiac cysts, they can also enlarge and eventually result in compromise of other mediastinal structures.…”

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

“…All diagnosed cysts showed as thin-walled, monocular, echo-free structures and with no obvious blood flow signals in two-dimensional echocardiographic images. It is reported that three-dimensional echocardiography adds incremental value to two-dimensional echocardiography in the detection of PCLs, not only allowing accurate measurements of cyst size, but also better demonstrating the structure of the cyst [ 15 , 16 ]. As mentioned above, the clinical features of the PCLs are nonspecific except the enteric cyst.…”

Pleuropericardial Cyst: A Review of the Literature

“…Treatment is indicated in the case of symptomatic, large-sized asymptomatic cysts, uncertain diagnosis and possibility of malignant potential, atypical location such as close to large vessels, high density on CT, or the presence of complications. Such treatment is required in order to prevent life-threatening emergencies such as airway and/or haemodynamic impairment, or patient's concern 23,32,40,41,[112][113][114] . Thus, any anterior mediastinal lesion should be considered potentially malignant and should be surgically excised as soon as possible 115 .…”