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Abstract
Pericardial cysts are very rare disorder with an incidence of about 1 in 1, 00,000. Pericardial cyst and diverticulum share similar developmental origin and may appear as an incidental finding in chest x ray in an asymptomatic patient. CT scan is considered as best modality for diagnosis and delineation of surrounding anatomy. Cardiac MRI is another excellent tool in diagnosis and evaluation of compressive effect and diffusion weighted cardiac MRI are very helpful for cases with diagnostic confusion. Echocardiography is best modality for follow up and image guided aspiration of the cyst. Conservative management with regular follow up may be considered if the cyst is small, patient is asymptomatic and probability of subsequent complication is low. Surgical resection should be considered in symptomatic patients, large cysts and with high probability of complications. Percutaneous aspiration and ethanol sclerosis is another attractive option.
Highlights
Cystic lesions within the pericardial space are a rare entity and comprise 7% of the mediastinal masses and 33% of mediastinal cysts [1,2]
Most cases are congenital and asymptomatic but life threatening complications may occur in the course of disease. They are found in the literature under various names: le kyste pleuropericardique (Jeaubert de Beaujeu, 1945; Roche, 1954), pleural cyst, pericardial cyst, pericardial coelomic cyst (Lambert, 1940), springwater cyst (Greenfield, Steinberg, and Touroff, 1943), mesothelial cyst (Churchill and Mallory, 1937), and thin-walled cyst [7]
Surgery is recommended in symptomatic patients, large cysts, radiological features of compression or impending compression to vital structures, uncertainty of malignant potential and prevention of life threatening emergencies such as cardiac tamponade, obstruction of right main stem bronchus and sudden death
Summary
Cystic lesions within the pericardial space are a rare entity and comprise 7% of the mediastinal masses and 33% of mediastinal cysts [1,2]. Pericardial cysts are commonly congenital in origin but other causes have been described in literature (Table 2) They usually arise from failure of fusion of one of the mesenchymal lacunae that form the pericardial sac [5]. For diagnosis of pericardial cyst and differentiate it from other diseases presenting as an isolated cystic shadow adjacent to the heart in chest x-ray (Figure 1) further imaging is necessary. Julius Chacha Mwita et al, [38] reported a case of a 22 year old female with a large (15 cmx cm) pericardial cyst compressing over right atrium and ventricle resulting in right heart failure. Pankaj Kaul and coworkers [39] described a case of massive benign pericardial cyst in a 66 year old woman presenting with tachycardia, dyspnoea engorged neck vein, purple discolouration of face, swelling of face and neck and wheeze over whole of right chest.
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