Abstract

IntroductionPericardial cysts are considered as a rare congenital abnormality, mostly found incidentally. The estimated incidence of pericardial cyst is 1:100,000 and represent approximately 6% of all mediastinal masses. Patients can present with symptoms similar to acute chest pain or right-sided heart failure or can be asymptomatic. PresentationA 46-year-old female who is known to have hypertension and hypothyroidism presented to the breast clinic with left breast mass that was proved by core needle biopsy as proliferative breast lesion. During the preoperative assessment, the patient reported progressive shortness of breath and cough over the last two years and bilateral lower limb edema. Her preoperative chest X-ray showed a well-defined oval like opacification at the right cardiophrenic angle that was proved by chest computed tomography imaging as a cystic mass od most likely a pericardial origin. A huge pericardial cyst originating from the right diaphragmatic surface was excised through a mini-sternotomy incision with smooth postoperative recovery. The patient-reported significant improvement in her symptoms and her lifestyle during her follow up. DiscussionPericardial cysts represent 6%–7% of all mediastinal masses with an estimated incidence of 1:100,000. About 70% of pericardial cysts originate at the right cardiophrenic angle and less frequently at the left cardiophrenic angle, they are usually suspected when the chest x-ray shows an enlarged contour of the right heart border. Mediastinal cysts have many differential diagnoses and the preoperative decision might be challenging in many cases. Pericardial cysts appear as oval, thin-walled homogeneous masses on cardiac computed tomography. The choice between surgical intervention and conservative follow up is related mainly to the size and symptoms that are induced by the cyst. ConclusionAs pericardial cysts are rarely diagnosed pathology, a high index of suspicion is essential for diagnosis. Surgical resection is indicated when they are huge, enlarging in size or symptomatic. Morbidity and mortality risks following pericardial cyst excision are very low.

Highlights

  • Pericardial cysts are considered as a rare congenital abnormality, mostly found incidentally

  • Pericardial cysts are considered as a congenital abnormality, mostly present with chest pain, shortness of breath, and cough [1], in few reported cases, huge pericardial cysts can be discovered incidentally in asymptomatic patients [2,3,4,5]

  • Most authorities recommend the removal of the cyst if the diagnosis is in doubt or if the patient complains of severe symptoms. Her in; we present a case of a 46-year-old lady with a huge pericardial cyst that was discovered incidentally during her preoperative assessment for breast surgery, and its surgical anesthetic considerations

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Summary

Introduction

Pericardial cysts are considered as a congenital abnormality, mostly present with chest pain, shortness of breath, and cough [1], in few reported cases, huge pericardial cysts can be discovered incidentally in asymptomatic patients [2,3,4,5]. Pericardial cysts can be discovered incidentally on x-ray but CT or MRI chest is the preferable method for diagnosis. Most authorities recommend the removal of the cyst if the diagnosis is in doubt or if the patient complains of severe symptoms Her in; we present a case of a 46-year-old lady with a huge pericardial cyst that was discovered incidentally during her preoperative assessment for breast surgery, and its surgical anesthetic considerations. This case is reported in concordance with the SCARE 2018 criteria [7]

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