Abstract
Pericardial cysts are rare mediastinal cysts composed of a single fluid-filled mesothelial layer and can be congenital in origin or develop secondary to pericarditis, trauma, or infection. Although most pericardial cysts are asymptomatic, life-threatening complications can occasionally occur. We report on a 57-year-old man with an asymptomatic 9 cm pericardial cyst that was incidentally found as an abnormal cardiac silhouette on routine chest radiography. Further imaging confirmed the presence of a pericardial cyst that was compressing the right atrium. The patient underwent successful video-assisted thoracoscopic removal of the pericardial cyst under general anesthesia. The patient's postoperative course was uneventful and he was discharged on postoperative day 1 in a stable condition. To our knowledge, this is the first report regarding the anesthetic management of a patient with a giant pericardial cyst undergoing thoracic surgery. Knowledge regarding the perioperative challenges associated with the removal of pericardial cysts can prevent complications and improve patient outcomes.
Highlights
Pericardial cysts are rare entities and comprise 7% of all mediastinal masses
The reported incidence of pericardial cysts is 1 in 100,000 population per year [1, 2]. These cysts are usually detected in individuals in their third or fourth decade of life and there is no difference in the incidence of pericardial cysts between males and females [3]
Pericarditis, bacterial or parasitic infection, trauma, and cardiac surgery may result in formation of pericardial cysts [4]
Summary
The reported incidence of pericardial cysts is 1 in 100,000 population per year [1, 2]. The treatment options for pericardial cysts include observation, percutaneous drainage, and surgical resection. Video-assisted thoracoscopic surgery (VATS) is a valuable intervention for resection of pericardial cysts with lower morbidity and mortality rates than thoracotomy [5]. The duration of surgery and postoperative hospital stay after intrathoracic cyst resection is lower in patients who undergo VATS in comparison to those who undergo thoracotomy. There are several case reports on patients with pericardial cysts in the literature [1, 5,6,7,8,9]. We present a patient with a giant pericardial cyst compressing the right atrium who underwent VATS excision. We discuss the perioperative anesthetic management of this patient
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