P1829 A middle aged man with pericardial cyst

Abstract

Abstract Introduction Pericardial cysts are rare benign congenital anomaly that are usually accidentally discovered as a mass obliterating the costophrenic angle. The reported incidence is one to 100,000 with males are equally affected as females. They are usually asymptomatic; however, they can cause chest pain, shortness of breath and dry cough. Case report We present a 62 years old gentleman who presented with increasing shortness of breath. He was a heavy smoker and was known to have COPD. He was also known to have chronic heart failure with an EF of 40% and had a previous history of pericardial cyst that was initially discovered when he was investigated for shortness of breath. The patient had a one-month history of feeling more dyspneic than usual. His chest auscultation revealed scattered rhonchi and no murmurs were heard on auscultation of the heart. His ECG showed no new abnormality and his chest x-ray showed abnormal right cardio mediastinal silhouette with large opaque area adjacent to the right heart border and the size of the opacity the same compared to his previous x rays. An Echocardiography was done and this showed moderate to severe impairment of left ventricular systolic function with an EF of 30-35%, mild to moderate mitral regurgitation and showed a cystic lesion anterior to the right ventricle. A CT chest was done for evaluation of the pericardial cyst and showed centrilobular emphysema and a mass in the rt lung abutting the right border of the heart with a maximum diameter of 8.7 cm. The patient was non-compliant to his medications and repeatedly missed his follow up appointments. He also continued to smoke despite progression of his COPD. The cause of his shortness of breath was likely due to progression of heart failure and COPD with the pericardial cyst probably has no or minimal rule. Conclusion Pericardial cysts are rarely symptomatic and usually has a benign course. We aimed at increasing awareness of this rare benign animally. Abstract P1829 Figure.