A Patient with Left Cardiophrenic Angle Mass Presenting with Intermittent Chest Symptoms

Abstract

A 42-year-old male shopkeeper presented in the out-patient department (OPD), with intermittent cough for the last six months along with occasional compressive symptoms at the centre of chest and mild dyspnea on exertion. Detailed cardiological history was not contributory. Chest on auscultation showed diminished air entry in the left infra-scapular region with occasional crepitations; the right side of the chest and other systemic examinations were within normal limits. Chest X-ray postero-anterior (PA) view revealed a lobular opacity in the left cardio-phrenic angle. (Fig. 1) Figure 1 Chest X-ray PA view showing a lobular opacity at the left cardio-phrenic angle large enough to obscure the left costo-phrenic angle, shown by the arrow. Routine blood investigations and 12-lead electrocardiography (ECG) revealed no abnormality. Two-dimensional echocardiography revealed a large well defined mass having echo-free space measuring 9.0 × 5.6 cm, resting on the postero-lateral side of the left ventricle (LV) without any connection to ventricular cavity (Fig. 2). But due to poor window, the exact morphological and anatomical nature of the mass could not be substantiated. Later contrast enhanced computed tomography (CECT) scan of the chest confirmed (Fig. 3), a large well circumscribed cystic lesion measuring 9.8 cm (antero-posterior) × 6.4 cm (supero-inferior) × 5.5 cm (transverse) in the left lower hemi-thorax, abutting the lateral aspect of the pericardial cavity, not separable from it and indenting the lateral wall of the LV. It had thin barely perceptible wall, homogeneous fluid attenuation content, without any foci of calcification, contrast enhancement, or internal septa. Figure 2 2-D echocardiography showed a large well defined mass having echo-free space near the postero-lateral side of left ventricle (shown by interrogation mark). Figure 3 CECT chest showing a large well circumscribed cystic lesion in left lower hemi-thorax, abutting lateral aspect of pericardial cavity. Question What is the diagnosis?