Pericardial Cyst: Never Too Late to Diagnose

Abstract

Pericardial cysts are uncommon benign lesions of the middle mediastinum, making up less than 6% of all mediastinal masses. They are often detected as incidental findings on chest imaging and some can resolve spontaneously. Rarely, however, they may cause symptoms of chest pain, right ventricular outflow obstruction, and persistent cough. Furthermore, they may affect cardiac tamponade after acute rupture or cyst haemorrhage resulting in sudden death. We report the case of a 102-year-old woman presenting with urosepsis, in whom routine chest radiography was initially suspicious of advanced bronchial carcinoma. Further imaging supported a diagnosis of one of the largest pericardial cysts described in the literature located in the right parahilar space. The patient was appropriately managed conservatively.

Symptomatic pericardial cysts and dilemmas in their diagnosis

“…Congenital PCs and diverticula display similar developmental origin, the cystic lesions being considered a remnant of a diverticulum, while acquired inflammatory cysts occur due to a loculated pericardial effusion [ 1 ]. Moreover, different studies suggested that PCs are always connected with the pericardium, although a visible tube-like structure between them is described only in 5% of cases [ 8 , 18 ].…”

“…These are primarily congenital anomalies, with an estimated incidence of 1:100 000 persons, which occur because of the incomplete separation of the pericardial coelom after the third week of gestation [ 2 , 6 , 7 , 8 ]. However, inflammatory cysts may also occur in the context of tuberculosis, echinococcosis, rheumatic pericarditis, trauma, including cardiothoracic surgery, or in patients on chronic hemodialysis, in exceptional cases [ 5 , 9 , 10 ].…”

“…More than 60% of PCs are diagnosed in the middle age [ 2 , 8 ]. However, PCs have been reported in literature in all ages, from children up to 102 years old patients [ 8 ].…”

“…Larger PCs are associated with different symptoms, according to their localization, such as chronic cough, chest pain, stridor, wheezing, dyspnea, retrosternal pressure, hemoptysis, fatigue, dysphagia, epigastric pain, tachycardia, palpitations, and cyanosis [ 5 , 13 , 14 ]. In rare cases, cardiac tamponade, atrial fibrillation, hiccups, intercostal neuralgia, superior vena cava syndrome, hoarseness, obstruction of the right main stem bronchus, hemidiaphragm paralysis, spontaneous pneumothorax, and right ventricular outflow tract obstruction, due to the adjacent structure’s compression, have been reported [ 5 , 8 , 14 , 15 ].…”

Prenatal ultrasound diagnosis of fetal giant pericardial cyst: A case report

“…[1,2] Pericardial cysts are caused by incomplete fusion of pericardial mesenchymal Spaces in the embryo and consist of a thin layer of fibrous tissue lined with a single layer of mesothelial cells. [3] On echocardiography, pericardial cysts appear as single or multilocular cystic anechoic structures with thin walls and no obvious blood flow signal. They are most common in the right costophrenic Angle, followed by the left costophrenic Angle, and rarely located in other parts of the mediastinum.…”