Pericardial cyst occurs rarely, with one person affected in 100,000 [1] [2]. The cysts constitute less than ten percent of mediastinal masses and about a third of mediastinal cysts [3]. They range in size from about 2 cm to almost 30 cm [4], with a layer of mesothelial cells lining them [2]. The cysts are usually congenital [1], and originate from the pericardial coelom as the result of abnormal embryonic development [5]. They are most often found at the right cardiophrenic angle [2]. Alternative names include springwater cyst because the fluid inside the cysts has been characterized as crystal clear [5]. Otto Pickhardt performed the first resection of a pericardial cyst and found an orange-sized, shiny cyst [5] [6].

Most patients are asymptomatic and the cysts are discovered on radiographs or echocardiograms obtained for unrelated reasons. Symptoms, if they occur, are most often caused by compression of neighboring structures. The most frequent symptoms of pericardial cysts are chest pain, dyspnea, and cough.

Rare but serious complications can arise. One of these is cardiac tamponade, which is usually caused by rupture of the cyst inside the pericardium [6], or by hemorrhage from the cyst [7] [8]. Chest pain and signs of respiratory tract infection have been reported [9]. Pulmonary stenosis, right ventricular outflow obstruction, and infection of the cyst can also occur [10]. Giant cysts have been described, one that slowly grew to a size that held two and a half liters of fluid [11], and another that resulted in the unusual symptom of recurrent syncope because of compression of the right ventricle [12]. A pericardial cyst may infrequently erode adjacent structures, such as the superior vena cava [13], or partially erode into the right ventricular wall [14]. The cysts can occasionally resolve without intervention.

• Chest Discomfort

  Herein, we present a case of pericardial cyst compressing the left atrium complicated by a pericardial effusion and pleural effusion in a 62 year-old man with chest discomfort and dyspnoea. [ncbi.nlm.nih.gov]

  She had experienced 30 years of atypical chest discomfort. The symptoms did resolve by a surgical procedure, removing the pericardium. Please feel free to download Dr. Money’s case report and literature review to read more. [pcaofhagerstown.com]

  Case reports Case 1 A 48-year-old woman sought care for chest discomfort, generalized fatigue, and dyspnoea with minimal exertion. The symptoms were of 10 months' duration. After exercise, her dyspnoea typically lasted for about 2 or 3 h. [academic.oup.com]

• Developmental Disorder

  Mediastinal foregut duplication cysts are rare congenital masses caused by developmental disorders of the anterior part of the embryonic primitive gut. In adults they can be discovered as an incidental finding on chest radiograph. [ncbi.nlm.nih.gov]

• Persistent Cough

  Symptomatic pericardial cysts present with dyspnoea, chest pain, or persistent cough. [mayoclinic.pure.elsevier.com]

  If present, symptoms are usually due to compression of adjacent organs and include atypical chest pain, dyspnea, and persistent cough[2]. [ctsnet.org]

  Symptoms, when present, are usually due to compression of adjacent organs and in-clude atypical chest pain, dyspnoea and persistent cough [5]. [documents.tips]

• Rhinitis

  The latter could have been related to allergic rhinitis. [elsevier.pt]

• Ejection Murmur

  The jugular venous pressure was elevated and a grade 2/6 systolic ejection murmur was found. The lungs were clear. Abdominal examination revealed hepatomegaly and ascites. A clinical diagnosis of right sided heart failure was made. [panafrican-med-journal.com]

  The patient had elevated jugular venous pressure, bilateral pitting pedal edema, engorged superficial veins in lower limb, ascites, hepatomegally, left varicocele and a grade 2/6 systolic ejection murmur over the precordium. [interventional-cardiology.imedpub.com]

Imaging methods include plain radiography, echocardiography, computed tomography (CT) scans, and magnetic resonance imaging (MRI). Computed tomography is regarded as the method of choice, because it is helpful in determining the location of lesions, and detects pericardial thickening, and other defects [2] [15]. CT can distinguish masses derived from mediastinal structures from those arising outside the mediastinum. CT scans can also differentiate cystic structures from solid ones. In problematic cases, injection of contrast material into the cyst may aid in the diagnosis [2]. Most pericardial cysts show well-defined, non-enhancing attenuation on CT scans [15]; however, protein content in the cysts interferes with attenuation. Hemorrhagic cysts show hyperattenuation.

MRI is also helpful in diagnosis and follow-up examinations. It yields a high signal intensity on T2 weighted images, and a low signal intensity on T1 weighted images. This is altered in cysts containing a high concentration of protein. Diffusion weighted images may be useful in certain cases [16].

Ultrasound techniques are not the generally favored method for diagnosing pericardial cysts, although echocardiography can be a useful tool for determining the location of the cyst, and for differentiating it from other structural anomalies [2]. Echocardiography has the advantage over CT in that no ionizing radiation is involved [1].

• Mediastinal Mass

  Patient with a mediastinal mass may be diagnosed incidentally or following evaluation for the symptoms due to compressive effects on the adjoining structures. Pericardial cysts account to 6% of mediastinal masses. [ncbi.nlm.nih.gov]

  Pericardial cysts represent 6% of mediastinal masses. See the differential diagnosis of caridophrenic angle masses here. About radiologypics I am a radiology physician from California, USA. [radiologypics.com]

  […] lesion mediastinal teratoma Morgagni hernia Promoted articles (advertising) [radiopaedia.org]

• Anterior Mediastinal Mass

  View Article PubMed Google Scholar Uchiyama A, Shimizu S, Murai H, Ohshima A, Konomi H, Ogura Y, Ishikawa N, Yamashita H, Matsumoto S, Kuroki S, Tanaka M: Infrasternal mediastinoscopic surgery for anterior mediastinal masses. [casesjournal.biomedcentral.com]

• Right Axis Deviation

  A clinical diagnosis of right sided heart failure was made. The electrocardiography detected sinus tachycardia of 104 beats per minutes, right axis deviation, an incomplete right bundle-branch block and no conduction disturbances. [panafrican-med-journal.com]

  The electrocardiography detected right axis deviation and incomplete right bundle-branch block. In echocardiography the inferior vena cava and hepatic veins were dilated without respiratory variation in size of the inferior vena cava. [interventional-cardiology.imedpub.com]

• Right Bundle Branch Block

  A clinical diagnosis of right sided heart failure was made. The electrocardiography detected sinus tachycardia of 104 beats per minutes, right axis deviation, an incomplete right bundle-branch block and no conduction disturbances. [panafrican-med-journal.com]

  The electrocardiography detected right axis deviation and incomplete right bundle-branch block. In echocardiography the inferior vena cava and hepatic veins were dilated without respiratory variation in size of the inferior vena cava. [interventional-cardiology.imedpub.com]

• Incomplete Right Bundle Branch Block

  A clinical diagnosis of right sided heart failure was made. The electrocardiography detected sinus tachycardia of 104 beats per minutes, right axis deviation, an incomplete right bundle-branch block and no conduction disturbances. [panafrican-med-journal.com]

  The electrocardiography detected right axis deviation and incomplete right bundle-branch block. In echocardiography the inferior vena cava and hepatic veins were dilated without respiratory variation in size of the inferior vena cava. [interventional-cardiology.imedpub.com]

Although definitive diagnosis and management were not accomplished at the bedside in this case, an abnormal finding on FOCUS prompted further investigation and timely treatment. [ncbi.nlm.nih.gov]

Table 2 Summary of published case series of patients with pericardial cysts First author/reference Publication year Total no. of patients No. of symptomatic patients Presenting symptoms Treatment in symptomatic patients Feigin 1 1977 82 34 Chest pain, [academic.oup.com]

Surgical resection is the only definitive treatment for pericardial cysts. [ismics.org]

This cyst generally presents a favorable prognosis, although its natural history is not completely known. 3 The literature reports cases ranging from spontaneous disappearance to recurrence after surgical resection, as well as serious, even fatal complications [revespcardiol.org]

Signal characteristics are those of fluid and include 4 : T1: typically low signal (occasionally can be high signal if contains proteinaceous material) T2: high signal T1 C+ (Gd): no enhancement Treatment and prognosis They are benign lesions. [radiopaedia.org]

Furthermore, neither of the available non-invasive imaging modalities is sufficiently reliable to differentiate pericardial cysts from other pericardial masses with similar appearances but with different prognosis and treatments. 1 The differential diagnosis [elsevier.pt]

Prognosis The prognosis after resection of a mediastinal tumor varies widely, depending on the type of lesion resected. After resection of mediastinal cysts and benign tumors, the prognosis is generally excellent. [9] Donahue JM, Nichols FC. [emedicine.medscape.com]

What is the prognosis of Pericarditis? Will it ever go away? Please help! Allan_Klein,_MD: The connective tissue disease associated pericarditis is driven by the rheumatologic condition. Therefore, adequate treatment of the CTD is important. [my.clevelandclinic.org]

A pericardial cyst is a rare finding and is frequently congenital in etiology. Pericardial cysts are most commonly incidental findings and have no clinical significance. [healio.com]

The etiology of sudden cardiac death involves a wide range of diseases, but seldom pericardial cysts. A pericardial cyst is an uncommon cyst usually located in the middle mediastinum and rarely in the posterior part. [ncbi.nlm.nih.gov]

A concept of etiology and report of cases. J Thorac Surg 1950;20:494–504. PubMed Google Scholar 4. Kutlay H, Yavuzer I, Han S, et al. Atypically located pericardial cysts. Ann Thorac Surg 2001;72:2137–2139. PubMed CrossRef Google Scholar 5. [link.springer.com]

Etiology of pericardial cyst6 1.Congenital 2.Inflammatory: Rheumatic pericarditis, Bacterial infection particularly tuberculosis, Echinococcosis 3.Traumatic 4.Post cardiac surgery Table 2 : Etiology of pericardial cyst6. [interventional-cardiology.imedpub.com]

Most are congenital, although several acquired cases with an infectious, inflammatory, or traumatic etiology have been described. [revespcardiol.org]

The main differential diagnosis considered before surgery was hydatid cyst, due to the patient's occupational background, local epidemiology and eosinophilia. The latter could have been related to allergic rhinitis. [elsevier.pt]

Epidemiology A review of collected series reveals that many mediastinal neoplasms and masses vary in incidence and presentation depending on patient age. [emedicine.medscape.com]

Pathophysiology Tumors and cysts of the mediastinum can produce abnormal effects at both systemic and local levels. [emedicine.medscape.com]

In order to prevent complications, the giant pericardial cyst was excised outside of the pericardium with median sternotomy. [ncbi.nlm.nih.gov]

In order to prevent complications, the giant pericardial cyst was excised outside of the pericardiumwith median sternotomy. [journals.co.za]

Diagnosis is confirmed with computed tomography or magnetic resonance imaging, and surgical treatment is indicated for symptomatic patients. 1, 2 Watchful observation may be feasible for asymptomatic patients, but outcome data are lacking and thus preventive [westjem.com]

The indications for resection of pericardial cysts include large size, symptoms, patient concern, uncertainty of malignant potential, and prevention of the life threatening emergencies. [ctsnet.org]

The indications for resection of pericardial cysts are large size, symptoms, patient concern, uncertainty of malignant potential, and prevention of the life threatening emergencies. [keralamedicaljournal.com]

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