Pleuropericardial Cyst: A Review of the Literature

Abstract

Background: Pleuropericardial cysts (PPCs), account for 5 -10% of all mediastinal tumours, are rare lesions occurring in approximately 1 in 100000 persons and are usually congenital and rarely acquired. They are detected postmortem or incidentally on routine chest X-ray (CXR) and in most cases multi detector Computer Tomography is used to confirm the diagnosis. As benign course and clinical latency are characteristic features of such cysts and the occurrence of complications is rare, the majority of them can be left untreated. Methods:The aim of the study is to review the literature regarding PPCs and create a table which summarises all the published cases in order to draw a conclusion about the epidemiology, as well as the diagnostic and therapeutic approach to PPCs exclusively. We reviewed retrospectively the clinical manifestation, diagnostic and therapeutic approach in 101 cases of PPCs since the 19 th century Results: Our statistical analysis led to the following results: mean age of initial detection: 48.7 ± 17.2 years, female:male ratio: about 3:2, presence of symptomatology: 37/101 cases, most common location: right cardiophrenic angle (RCPA), most common method of initial detection: CXR in 49/101 cases, mean maximal diameter: 8,3 ± 3 cm. Conclusion:The management of a pleuropericardial cyst should be based on an algorithm in which the cyst's size, shape and compressibility along with clinical presentation and patient's fitness and preferences are be taken into consideration. When interventional is required, surgical resection by means of traditional open surgery or minimally invasive methods are considered to be the gold standard and along with percutaneous aspiration are the methods that have mostly been used.

Epigastric pain with incidental finding on a chest radiograph

“…Surgical excision of the cyst has been considered the gold standard of management (especially in complicated cases) with excellent outcomes. 2 Our patient was found to have H. pylori infection and began triple therapy. The patient was given an outpatient follow-up for a CT scan of chest to further evaluate the cyst.…”

“… 1 They are detected incidentally on routine chest X‐rays or post‐mortem. 2 Although most PPCs are asymptomatic, patients may present with chest pain or dyspnea but can occasionally cause life‐threatening complications, such as pericardial tamponade. 3 , 4 , 5 …”

“…Surgical excision of the cyst has been considered the gold standard of management (especially in complicated cases) with excellent outcomes. 2 …”

“…1 They are detected incidentally on routine chest X-rays or post-mortem. 2 Although most PPCs are asymptomatic, patients may present with chest pain or dyspnea but can occasionally cause life-threatening complications, such as pericardial tamponade. [3][4][5] Asymptomatic cases are managed conservatively with a close follow-up using non-contrast computed tomography (CT), ultrasound, or magnetic resonance imaging (MRI).…”

“…Pleuropericardial cysts (PPCs) are rare mediastinal lesions, usually congenital, benign, and are rarely acquired or malignant 1 . They are detected incidentally on routine chest X‐rays or post‐mortem 2 . Although most PPCs are asymptomatic, patients may present with chest pain or dyspnea but can occasionally cause life‐threatening complications, such as pericardial tamponade 3–5 …”