A Cyst Close to the Heart

Abstract

A 49-year-old Lebanese man presented to the hospital with right-sided pleuritic chest pain without associated respiratory or systemic symptoms. His vitals on presentation were stable, and examination was unremarkable. He had mild leukocytosis with 9.8% eosinophils. Imaging including cardiac magnetic resonance imaging with and without contrast revealed an extra pericardial, multiloculated anterior mediastinal cyst (Figure 1). A diagnosis of hydatid cyst was suspected based on epidemiologic history and radiologic appearance. Echinococcus serology was found to be positive. Patient was started on empiric anthelminthic treatment followed by surgical excision. Intraoperatively, the wall of the excised cyst showed calcification and sebaceous contents (Figure 2). Histopathologic exam showed multilocular cyst lined by squamous epithelial cells and foci of mature bone tissue (Figure 3), pancreatic acini, and ciliated columnar epithelial ducts consistent with a diagnosis of benign mature cystic teratoma. No parasite was seen. Anthelminthic therapy was discontinued, and the patient reported to be doing well on the follow-up visit. Similar cases have been reported in the past.1Patel I.J. Hsiao E. Ahmad A.H. Schroeder C. Gilkeson R.C. AIRP Best Cases in radiologic-pathologic correlation: mediastinal mature cystic teratoma.RadioGraphics. 2013; 33: 797-801Crossref PubMed Scopus (19) Google Scholar, 2Jaakik B. Benjelloun H. A Rare pericardial cyst resembling hydatid cyst on echocardiography.Intern Med. 2010; 49: 1673-1674Google Scholar, 3Montebello A. Mizzi A. Cassar P.J. Cassar K. Benign cystic mediastinal teratoma presenting as a massive pleural effusion in a 17-year–old boy.BMJ Case Reports. 2017; 2017 (bcr2016217439)Google ScholarFigure 2View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3View Large Image Figure ViewerDownload Hi-res image Download (PPT) The authors wish to acknowledge Dr Khushi Nagori, MBBS, Department of Pathology, Ascension St John Hospital, Detroit, Michigan.