Asymptomatic Cysts Research Articles

Abscess in a Previously Asymptomatic Bronchogenic Cyst After Transbronchial Needle Aspiration

Abscess in a Previously Asymptomatic Bronchogenic Cyst After Transbronchial Needle Aspiration

Medical treatment versus "Watch and Wait" in the clinical management of CE3b echinococcal cysts of the liver.

BackgroundAvailable treatments for uncomplicated hepatic cystic echinococcosis (CE) include surgery, medical therapy with albendazole (ABZ), percutaneous interventions and the watch-and-wait (WW) approach. Current guidelines indicate that patients with hepatic CE should be assigned to each option based on cyst stage and size, and patient characteristics. However, treatment indications for transitional CE3b cysts are still uncertain. These cysts are the least responsive to non-surgical treatment and often present as indolent, asymptomatic lesions that may not warrant surgery unless complicated. Evidence supporting indications for treatment of this stage is lacking. In the attempt to fill this gap before the implementation of randomized clinical trials, we compared the clinical behavior of single hepatic CE3b cysts in 60 patients followed at the WHO Collaborating Centre for Cystic Echinococcosis of the University of Pavia.MethodsWe analyzed retrospectively data of 60 patients with hepatic CE3b cysts seen at our clinic over 27 years, who either received ABZ or were monitored with WW. Univariate and multivariate analysis were performed to investigate the effect on outcome (inactivation or relapse) of variables such as age, sex, origin, treatment, cyst size and presence of other echinococcal hepatic cysts using a multiple failure Cox proportional hazard model.ResultsABZ treatment was positively associated with inactivation (p < 0.001), but this was not permanent, and no association was found between therapeutic approach and relapse (p = 0.091). No difference was found in the rate of complications between groups.ConclusionsIn conclusion, our study shows that ABZ treatment induces temporary inactivation of CE3b cysts, while during WW cysts remain stable over time. As the rate of adverse events during periods of ABZ treatment and WW did not differ significantly in the follow-up period considered in this study (median 43 months, IQR 10.7-141.5), expectant management might represent a valuable option for asymptomatic CE3b cysts when strict indication for surgery is absent and patients comply with regular long-term follow-up.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-492) contains supplementary material, which is available to authorized users.

Thornwaldt Cysts

Thornwaldt cysts are rare and benign congenital cysts in the region of the pharyngeal bursa, formed by a communication between the notochord and the nasopharyngeal endoderm. They result from a mechanical obstruction, inflammation, or abscess of the pharyngeal bursa. They are superficial to the superior constrictor muscle and covered by the nasopharyngeal mucous membrane. Most cases are asymptomatic, and patients may rarely present symptoms such as nasal obstruction, foreign body sensation, hearing loss, and periodic halitosis. Therefore, they are often accidentally diagnosed on MRI. Asymptomatic cysts do not require treatment, whereas symptomatic cases require surgical intervention by endonasal or transoral approach. Marsupialization is the procedure of choice to avoid recurrences. The aim of this article is to present and discuss 2 cases of Thornwaldt cysts.

Dermoid Cyst Excision under Müller Muscle in a Patient with Blepharoptosis.

Dermoid Cyst Excision under Müller Muscle in a Patient with Blepharoptosis.

Gamma ventral capsulotomy for obsessive-compulsive disorder: a randomized clinical trial.

Select cases of intractable obsessive-compulsive disorder (OCD) have undergone neurosurgical ablation for more than half a century. However, to our knowledge, there have been no randomized clinical trials of such procedures for the treatment of any psychiatric disorder. To determine the efficacy and safety of a radiosurgery (gamma ventral capsulotomy [GVC]) for intractable OCD. In a double-blind, placebo-controlled, randomized clinical trial, 16 patients with intractable OCD were randomized to active (n = 8) or sham (n = 8) GVC. Blinding was maintained for 12 months. After unblinding, sham-group patients were offered active GVC. Patients randomized to active GVC had 2 distinct isocenters on each side irradiated at the ventral border of the anterior limb of the internal capsule. The patients randomized to sham GVC received simulated radiosurgery using the same equipment. Scores on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Clinical Global Impression-Improvement (CGI-I) Scale. Response was defined as a 35% or greater reduction in Y-BOCS severity and "improved" or "much improved" CGI-I ratings. Three of 8 patients randomized to active treatment responded at 12 months, while none of the 8 sham-GVC patients responded (absolute risk reduction, 0.375; 95% CI, 0.04-0.71). At 12 months, OCD symptom improvement was significantly higher in the active-GVC group than in the sham group (Y-BOCS, P = .046; Dimensional Y-BOCS, P = .01). At 54 months, 2 additional patients in the active group had become responders. Of the 4 sham-GVC patients who later received active GVC, 2 responded by post-GVC month 12. The most serious adverse event was an asymptomatic radiation-induced cyst in 1 patient. Gamma ventral capsulotomy benefitted patients with otherwise intractable OCD and thus appears to be an alternative to deep-brain stimulation in selected cases. Given the risks inherent in any psychiatric neurosurgery, such procedures should be conducted at specialized centers. clinicaltrials.gov Identifier: NCT01004302.

Differences in the distribution and presentation of bronchogenic cysts between adults and children

BackgroundBronchogenic cysts are rare congenital malformations that occur in adults and children, with differences in distribution and presentation. MethodsThe study population comprised 16 infants and children (aged 7days to 18years) and 23 adults (aged 20–78 years) who received pathological diagnoses of bronchogenic cysts over a 14-year period (1999–2012). Cyst distribution and presentation were reviewed. ResultsHalf (8/16) of the infants and children presented with palpable masses in the neck (n=6) or on the skin (n=2), and only one (12.5%) presented with symptoms of mild stridor. Another eight pediatric patients had mediastinal (n=7) or pulmonary (n=1) bronchogenic cysts, and respiratory symptoms were present in six (75%) patients.Thirteen of 23 (56.5%) adult patients had asymptomatic cysts (neck, n=1; mediastinum, n=11; lung, n=1). Symptomatic presentations occurred in 10/23 (43.5%) patients, including 2 with palpable mass in the neck, 3 in the mediastinum, 4 in the lung, and 1 in the retroperitoneum. Among the 13 asymptomatic patients, 6 were identified during regular health screening, 5 during routine chest computed tomographic surveys for cancer, and 2 incidentally found during thyroid and parathyroid surgery. Bronchogenic cysts tended to be larger in symptomatic than in asymptomatic adults. ConclusionThe clinical spectra of bronchogenic cysts differ between adults and children and are closely related to cyst location and, probably, size.

Management of pancreatic ductal leaks and fistulae

Pancreatic duct leaks can occur as a result of both acute and chronic pancreatitis or in the setting of pancreatic trauma. Manifestations of leaks include pseudocysts, pancreatic ascites, high amylase pleural effusions, disconnected duct syndrome, and internal and external pancreatic fistulas. Patient presentations are highly variable and range from asymptomatic pancreatic cysts to patients with severe abdominal pain and sepsis from infected fluid collections. The diagnosis can often be made by high-quality cross-sectional imaging or during endoscopic retrograde cholangiopancreatography (ERCP). Because of their complexity, pancreatic leak patients are best managed by a multidisciplinary team comprised of therapeutic endoscopists, interventional radiologists, and surgeons in the field of pancreatic interventions. Minor leaks will often resolve with conservative management while severe leaks will frequently require interventions. Endoscopic treatments for pancreatic duct leaks have replaced surgical interventions in many situations. Interventional radiologists also have the ability to offer therapeutic interventions for many leak patients. The mainstay of endotherapy for pancreatic leaks is transpapillary pancreatic duct stenting with a stent that bridges the leak if possible, but varies based on the manifestation and clinical presentation. Fluid collections that result from leaks, such as pseudocysts, can often be treated by endoscopic transluminal drainage with or without endoscopic ultrasound or by percutaneous drainage. Endoscopic interventions have been shown to be effective and have an acceptable complication rate.

Outcomes of ovarian transposition in gynaecological cancers; a systematic review and meta-analysis.

BackgroundPelvic irradiation is essential for improving survival in women with pelvic malignancies despite inducing permanent ovarian damage. Ovarian transposition can be performed in premenopausal women in an attempt to preserve ovarian function. As uncertainty occurs over the proportion of women who are likely to benefit from the procedure, we performed a systematic review and meta-analysis of the proportion of women with ovarian function preservation, symptomatic or asymptomatic ovarian cysts and metastatic ovarian malignancy following ovarian transposition.MethodsMedline, Embase and The Cochrane Library databases were systematically searched for articles published from January 1980 to December 2013. We computed the summary proportions for ovarian function preservation, ovarian cyst formation and metastatic ovarian disease following ovarian transposition by random effects meta-analysis with meta-regression to explore for heterogeneity by type of radiotherapy.ResultsTwenty four articles reporting on 892 women undergoing ovarian transposition were included. In the surgery alone group, the proportion of women with preserved ovarian function was 90% (95% CI 92–99), 87% (95% CI 79–97) of women did not develop ovarian cysts and 100% (95% CI 90–111) did not suffer metastases to the transposed ovaries. In the brachytherapy (BR) ± surgery group, the proportion of women with preserved ovarian function was 94% (95% CI 79–111), 84% (95% CI 70–101) of women did not develop ovarian cysts and 100% (95% CI 85–118) did not suffer metastases to the transposed ovaries. In the external beam radiotherapy (EBRT) + surgery ± BR group, the proportion of women with preserved ovarian function was 65% (95% CI 56–74), 95% (95% CI 85–106) of women did not develop ovarian cysts and 100% (95% CI 90–112) did not suffer metastases to the transposed ovaries. Subgroup meta-analysis revealed transposition to the subcutaneous tissue being associated with higher ovarian cyst formation rate compared to the “traditional” transposition.ConclusionOvarian transposition is associated with significant preservation of ovarian function and negligible risk for metastases to the transposed ovaries despite common incidence of ovarian cysts.

PTH-103 The Management And Assessment Of Incidental Pancreatic Cysts On Computer Tomography In A Non-pancreatic Centre

IntroductionWith increased use and sensitivity of cross sectional imaging more incidental pancreatic cystic lesions are found. Studies have demonstrated a prevalence of 2.5% of cystic pancreatic lesions in asymptomatic patients...

Management of Neonatal Ovarian Cysts and its Effect on Ovarian Preservation

Background/PurposeManagement of asymptomatic neonatal ovarian cysts varies. Some surgeons advocate initial observation, while others recommend immediate operation depending on cyst size and complexity. This study aims to compare outcomes of initial observation versus primary surgery, focusing on incidence of postnatal torsion and ovarian preservation. MethodsA retrospective study (1997–2012) of neonates with an ovarian mass was performed. Data on cyst size, ultrasound characteristics, clinical course, complications, and pathology were extracted. ResultsThirty-seven neonates with asymptomatic ovarian cysts were identified (N=25 observed, N=12 primary surgery). Overall, 12/25 (48%) observed had successful cyst regression, including 3/8 (38%) cysts ≥50mm and 6/15 (40%) complex. 13/25 patients (52%) underwent surgery for failure of cyst regression (11/13) or concern for interval torsion (2/13). Postnatal torsion occurred in 1/25 observation patients (4%), or 1/8 (13%) with cysts≥50mm. Overall rate of ovarian preservation between groups was not statistically different [6/8 (75%) observed versus 8/9 (89%) primary surgery; P=0.577]. Pathology found viable ovarian tissue in all oophorectomy specimens (N=3). ConclusionsPostnatal torsion is rare. A period of observation spares half of neonates from an operation, without decreasing ovarian salvage. Initial management should consist of observation, regardless of size or complex characteristics. If operative intervention is necessary, ovary preserving techniques should be utilized.

Management of Non-Parasitic Splenic Cysts: Does Size Really Matter?

BackgroundSplenic cysts are relatively rare clinical entities and are often diagnosed incidentally upon imaging conducted for a variety of clinical complaints. They can be categorized as primary or secondary based on the presence or absence of an epithelial lining. Primary cysts are further subdivided into those that are and are not secondary to parasitic infection. The treatment of non-parasitic splenic cysts (NPSC) has historically been dictated by two primary factors: the presence of symptoms attributable to the cyst and cyst size greater or less than 5 cm. While it is appropriate to resect a symptomatic lesion, the premise of recommending operative intervention based on size is not firmly supported by the literature. MethodsIn the current study, we identified 115 patients with splenic cysts and retrospectively reviewed their management that included aspiration, resection, or observation. ResultsOur data reveal a negative overall growth rate of asymptomatic cysts, a high recurrence rate after percutaneous drainage, as well as demonstrate the safety of observing asymptomatic lesions over time. ConclusionWe conclude that observation of asymptomatic splenic cysts is safe regardless of size and that aspiration should be reserved for those who are not surgical candidates or in cases of diagnostic uncertainty.

Mo1167 Needle-Based Confocal Laser Endomicroscopy (nCLE) for the Diagnosis of Pancreatic Masses: Preliminary Criteria (Contact Study)

Introduction: With increased use and sensitivity of cross sectional imaging more incidental pancreatic cystic lesions are found. Studies have demonstrated a prevalence of 2.5% of cystic pancreatic lesions in asymptomatic patients on MRI & CT scanning. Cystic lesions have a wide variety of radiological appearances and prognostic outcomes. We aimed to review cases found to have incidental pancreatic cysts on CT scanning and ascertain the concordance between CT and EUS and the management of such lesions in a non-pancreatic centre. Method: We retrospectively reviewed patients undergoing EUS for pancreatic cystic lesions found on incidentally on CT scan between 2010 and 2012. Twenty-five patients were included. Solid lesions with a cystic component were excluded. Results: There were 15 female; 10 male. Indications for CT scan included abdominal pain 32%; weight loss 16%; jaundice and suspected stone disease with abnormal USS 16%. In all cases there was no preceding clinical suspicion of pancreatic cysts/disease. Median number of cysts was 1 (14); mean size 3cm (1-11cm). In 70% of cases the cyst was >3cm; and <3cm in 30%. They were located in the HOP 36%; BOP 32%; TOP 16%; NOP 4%; multiple sites 12%. The cyst was aspirated +/biopsy in 12 (48%) cases, of which in 2 (16%) this changed the CT diagnosis. Final diagnosis was pseudocyst 10 (40%); IPMN 6 (24%); simple cyst 2 (8%); serous cystadenoma 2 (8%); mucinous cystadenoma (MCA) 1 (4%); cystic adenoca 1 (4%); wegeners cyst 1 (4%); renal cyst 1 (4%). In 32% (8 cases), the EUS findings were inconsistent with CT findings, due to IPMN and MCA in the vast majority. Greatest concordance between EUS and CT findings was in the diagnosis of pseudocysts. Conclusion: Increasing number of asymptomatic pancreatic cysts found incidentally will undoubtedly cause increased referrals to tertiary pancreatic centres. EUS is a better imaging modality with additional benefit of attaining samples. Performing EUS +/cyst FNA provided an alternative diagnosis to CT in a significant percentage (32%) of patients and helped streamline referrals for tertiary opinion. EUS should be considered in all patients presenting with incidental pancreatic cysts on cross-sectional imaging. This may be performed at the index hospital (if non-pancreatic centre) and should not be restricted to tertiary HPB centres if operator experience and confidence allows.

Mo1166 The Management and Assessment of Incidental Pancreatic Cysts on Computer Tomography in a Non-Pancreatic Centre

Introduction With increased use and sensitivity of cross sectional imaging more incidental pancreatic cystic lesions are found. Studies have demonstrated a prevalence of 2.5% of cystic pancreatic lesions in asymptomatic patients on MRI and CT scanning. Cystic lesions have a wide variety of radiological appearances and prognostic outcomes. We aimed to review cases found to have incidental pancreatic cysts on CT scanning and ascertain the concordance between CT and EUS and the management of such lesions in a non-pancreatic centre. Methods We retrospectively reviewed patients undergoing EUS for pancreatic cystic lesions found on incidentally on CT scan between 2010 and 2012. Twenty-five patients were included. Solid lesions with a cystic component were excluded. Results There were 15 female; 10 male. Indications for CT scan included abdominal pain 32%; weight loss 16%; jaundice and suspected stone disease with abnormal USS 16%. In all cases there was no preceding clinical suspicion of pancreatic cysts/disease. Median number of cysts was 1 (1–4); mean size 3 cm (1–11 cm). In 70% of cases the cyst was >3 cm; and Conclusion Increasing number of asymptomatic pancreatic cysts found incidentally will undoubtedly cause increased referrals to tertiary pancreatic centres. EUS is a better imaging modality with additional benefit of attaining samples. Performing EUS +/- cyst FNA provided an alternative diagnosis to CT in a significant percentage (32%) of patients and helped streamline referrals for tertiary opinion. EUS should be considered in all patients presenting with incidental pancreatic cysts on cross-sectional imaging. This may be performed at the index hospital (if non-pancreatic centre) and should not be restricted to tertiary HPB centres if operator experience and confidence allows. Disclosure of Interest None Declared.

Incidental adnexal masses: the role of imaging in the management of the patient

Adnexal masses are a relatively common finding and are usually benign. When an adnexal mass is detected incidentally on cross-sectional imaging, it is important to ensure that the patient follows the most appropriate pathway and ultrasound will be the most appropriate intial imaging in most cases. Ultrasound can triage patients into three categories: 1. appropriately reassured that there are benign characteristics; 2. followed up for reassurance in likely benign cases; 3. Referred for further tests if there is a suspicion of possible malignancy. There are two helpful guidelines can be used when an adnexal mass is detected at ultrasound, either the IOTA simple rules or the Society of Radiologists in Ultrasound statement on managing asymptomatic ovarian cysts. In cases that are highly likely to be cancer, the next step includes referral to a cancer centre and staging with CT. In cases of a sonographically indeterminate adnexal mass, characterisation with MRI can further differentiate likely benign masses from malignant masses with a high specificity.

Incidental Pancreatic Cysts

The widespread adoption of multidetector computed tomography and magnetic resonance imaging (MRI) for evaluation of intraabdominal pathology has resulted to a steady increase in the number of incidentally discovered pancreatic cysts in clinical practice during the last decades. The differential diagnosis of these cysts is broad including pseudocysts, serous cystic neoplasms, mucinous cystic neoplasms, and intraductal papillary mucinous neoplasms. The MRI has an important role both in the initial characterization of incidentally detected pancreatic cysts and the follow-up of these lesions and has become an integral part of the diagnostic algorithm for pancreatic cysts at many institutions. The inherent soft-tissue contrast of magnetic resonance cholangiopancreatography provides the vehicle for providing a specific diagnosis in many pancreatic cysts. Furthermore, an MRI-based characterization of pancreatic cysts allows for selection of those cysts that are more likely to benefit from endoscopic ultrasound and fine-needle aspiration for analysis of the fluid contents. Moreover, small asymptomatic incidental pancreatic cysts without concerning MRI features such as internal septae and/or nodularity may be safely followed with serial imaging. The lack of risk associated to repeated exposure to ionizing radiation and its ability to characterize pancreatic cysts are strong arguments for selecting MRI as the preferred imaging modality for following up these lesions. However, the recommendations for imaging follow-up continue to evolve, and several of the proposed guidelines are reviewed in this manuscript.

Resectoscopic Ablation of the Gallbladder Mucosa After Cholecystostomy

To investigate the feasibility of endoscopic ablation of the gallbladder mucosa after cholecystostomy. The mucosa of the gallbladder was endoscopically electrocoagulated through the cholecystostomy tract. After ablation, repeated luminal irrigation with chymotrypsin solution was given before removal of the tube. The patients were followed up by ultrasonography after the procedure. Twenty patients accepted this operation. The mean operating time was 38 minutes (range, 25 to 55 min). There were no procedure-related mortality and complications including perforation, bleeding, and cholangitis. Eighteen gallbladders have completely obliterated in 3 months. The other 2 gallbladders developed asymptomatic retention cysts. During 48 months of follow-up period, no stone occurred and no signs of malignancy were found at the site of the gallbladder. Seven patients died from the other medical illness. Resectoscopic ablation of the gallbladder mucosa is a safe and promising approach to sclerosis of the gallbladder after cholecystostomy.

A Central Gartner's Duct Cyst, Unilateral Renal Agenesis, Didelphic Uteri and Paratubal Cyst Presenting as Pain and Fever: A Case Report and Review of the Literature

A Gartner's duct cyst (GDC) is a benign vaginal cystic lesion that arises from the mesonephric duct. GDC are usually small asymptomatic cysts that occur along the lateral walls of the vagina, but may enlarge. The ureteral bud also arises from the mesonephric duct. If the ureteral bud is located high or low with respect to the metanephric blastema, a dysplastic or hypoplastic kidney may result. The rare combination of GDC and unilateral renal agenesis has been reported in the literature, half of which are also associated with müllerian duct abnormalities.

Incidental pancreatic cysts: natural history and diagnostic accuracy of a limited serial pancreatic cyst MRI protocol

To examine the natural history of incidentally detected pancreatic cysts and whether a simplified MRI protocol without gadolinium is adequate for lesion follow-up. Over a 10-year period, 301-patients with asymptomatic pancreatic cysts underwent follow-up (45 months ± 30). The magnetic resonance imaging (MRI) protocol included axial, coronal T2-weighted images, MR cholangiopancreatographic and fat suppressed T1-weighted sequences before and after gadolinium. Three radiologists independently reviewed the initial MRI, the follow-up studies using first only unenhanced images, then secondly gadolinium-enhanced-sequences. Lesion changes during follow-up were recorded and the added value of gadolinium-enhanced sequences was determined by classifying the lesions into risk categories. Three hundred and one patients (1,174 cysts) constituted the study population. Only 35/301 patients (12 %) showed significant lesion change on follow-up. Using multivariate analysis the only independent factor of lesion growth (OR = 2.4; 95 % CI, 1.7-3.3; P < 0.001) and mural nodule development (OR = 1.9; 95 % CI, 1.1-3.4, P = 0.03) during follow-up was initial lesion size. No patient with a lesion initial size less than 2 cm developed cancer during follow-up. Intra-observer agreement with and without gadolinium enhancement ranged from 0.86 to 0.97. After consensus review of discordant cases, gadolinium-enhanced sequences demonstrated no added value. Most incidental pancreatic cystic lesions did not demonstrate change during follow-up. The addition of gadolinium-enhanced-sequences had no added-value for risk assignment on serial follow-up. Significant growth of pancreatic cysts occurred in a minority of patients only. No lesion <2 cm demonstrated any change during the first year of follow-up. Intra-observer agreement between MR pancreatic protocols with and without gadolinium was excellent. Gadolinium application had limited value for follow-up of asymptomatic pancreatic cystic lesions.

Association between allelic variation due to short tandem repeats in tRNA gene of Entamoeba histolytica and clinical phenotypes of amoebiasis

Genotypes of Entamoeba histolytica (E. histolytica) may contribute clinical phenotypes of amoebiasis such as amoebic liver abscess (ALA), dysentery and asymptomatic cyst passers state. Hence, we evaluated allelic variation due to short tandem repeats (STRs) in tRNA gene of E. histolytica and clinical phenotypes of amoebiasis. Asymptomatic cyst passers (n=24), patients with dysentery (n=56) and ALA (n=107) were included. Extracted DNA from stool (dysentery, asymptomatic cyst passers) and liver aspirate was amplified using 6 E. histolytica specific tRNA-linked STRs (D-A, A-L, N-K2, R-R, S-Q, and STGA-D) primers. PCR products were subjected to sequencing. Association between allelic variation and clinical phenotypes was analyzed. A total of 9 allelic variations were found in D-A, 8 in A-L, 4 in N-K2, 5 in R-R, 10 in STAG-D and 7 in S-Q loci. A significant association was found between allelic variants and clinical phenotypes of amoebiasis. This study reveals that allelic variation due to short tandem repeats (STRs) in tRNA gene of E. histolytica is associated different clinical outcome of amoebiasis.

Syncope in a patient with a large left ventricular hydatid cyst: An unusual presentation

Cardiac echinococcosis is one of the rare manifestations of hydatid disease that could be a serious and a life-threatening problem. The left ventricle is the most frequent site of the cardiac involvement. Hence cysts tend to grow towards the epicardium frequently, and they grow slowly; most of the cases have large and often asymptomatic cysts in their heart [1,2]. In this case report, we present a 72-year-old woman who was referred to our department complaining of palpitation with history of two syncopal attacks. The patient was finally diagnosed to have a large left ventricular hydatid cyst and underwent successful surgical excision. A 72-year-old Iranian woman with a history of hypertension was referred to our department for investigation of left hemithoracic mass. On admission she was complaining of palpitation and a vague resting chest discomfort. She had a history of two syncopal episodes in last month with a week interval. A plain chest roentgenogram done before referral to our hospital had revealed a large paracardiac mass on left hemithorax. At clinical examination, the patient was afebrile. The heart rate was 96 beats/min and the blood pressure was 130/ 70 mm Hg. Cardiac and chest auscultation was uncharacteristic. There was no organomegaly and abdominal examination was unremarkable. Neurological examination revealed no abnormalities aswell. The electrocardiogram showed T-wave inversion in leads I, II, aVL, V5, and V6. Computed tomography (CT) scan (Fig. 1) revealed a large paracardiac cystic mass in the left hemithorax with the possible origin of the lower lobe of the left lung or the heart. Transthoracic echocardiography (TTE) was also performed, showing a large cystic mass in the lateral wall of the