Pericardial Cyst Research Articles

High Prevalence of Estrogen and Progesterone Receptor Expression in Mediastinal Cysts Situated in the Posterior Mediastinum

To identify and estimate the prevalence of mediastinal cysts lined by the epithelium expressing steroid receptors. We retrieved 19 mediastinal cysts from our pathology files from 1996 to 2004, and examined estrogen receptor (ER) and progesterone receptor (PR) expressions in the cysts. Three paravertebral cysts, all in women, one bronchogenic cyst in a woman, nine thymic cysts, and six pericardial cysts were found in the pathology files. Paravertebral cysts were situated in the posterior mediastinum and were attached either to the left or the right of the vertebral column. All cysts were radiologically diagnosed before surgery as neurogenic tumors. They were excised by video-assisted thoracoscopic surgery. The epithelial lining of the cyst in all three cases was strongly positive for both ER and PR. A thymic cyst in one woman was weakly positive only for the ER. In all other cases, the lining was entirely negative for both ER and PR. Posterior mediastinal paravertebral cysts characteristically express ER and PR. They should be recognized as a distinct type of mediastinal cyst because they are biologically different from bronchogenic cysts, seem not to be infrequent, and sometimes are misdiagnosed as a neurogenic tumor.

Imaging features of primary mediastinal cysts with clinical and histopathologic correlation

目的 分析纵隔囊肿的影像学特点,提高对不同类型囊肿不典型表现的认识和诊断水平.方法回顾性分析经手术病理证实的44例纵隔囊肿的CT和(或)MRI资料(其中28和26例分别行CT和MR检查,10例同时行CT和MR检查),分析其影像学表现.结果囊肿位于前、中、后纵隔者分别为13、18和11例,位于前中纵隔者2例.支气管囊肿和心包囊肿位于不典型部位者分别为7和5例.CT密度近似于水者12例,占42.9%(12/28).MR T2WI病变均为等或高于脑脊液的长T2信号,1例水成像上信号有衰减.近似于脑脊液的长T1信号者8例,占30.8%(8/26).MRI信号不均匀者5例,原因各异.误诊14例.结论后纵隔和前纵隔CT高密度和厚壁的囊肿易被误诊为肿瘤性病变;中纵隔气管旁的心包囊肿易被误诊为支气管囊肿.MRI有助于诊断CT高密度的纵隔囊肿.MRI信号不均匀或水成像上信号衰减是误诊的原因。

Tumors of the Mediastinum

Tumors of the mediastinum represent a wide diversity of disease states. The location and composition of a mass is critical to narrowing the differential diagnosis. The most common causes of an anterior mediastinal mass include the following: thymoma; teratoma; thyroid disease; and lymphoma. Masses of the middle mediastinum are typically congenital cysts, including foregut and pericardial cysts, while those that arise in the posterior mediastinum are often neurogenic tumors. The clinical sequelae of mediastinal masses can range from being asymptomatic to producing symptoms of cough, chest pain, and dyspnea. This article will review the anatomy of the mediastinum as well as the different clinical, radiographic, and prognostic features, and therapeutic options of the most commonly encountered masses.

Methicillin-Resistant Staphylococcus aureus-Infected Pericardial Cyst

A 44-year-old man with no notable medical history presented with a 4-day history of progressive dyspnea, cough productive of whitish sputum, and swelling and rash over both lower extremities. The patient was afebrile, tachypneic, and tachycardic. Chest examination revealed decreased breath sounds at both lung bases. Scattered palpable purpura was noted on the lower extremities. Renal function was mildly impaired. Chest radiography showed cardiomegaly and pleural effusions bilaterally. Echocardiographic images suggested a mass involving the right ventricular free wall and mild tamponade. Contrast-enhanced computed tomography confirmed the presence of a loculated 10 × 8 × 6-cm pericardial cyst. Skin and kidney biopsy specimens revealed IgA depositions suggestive of adult Henoch-Schonlein purpura. Pleural fluid was exudative, and no organisms were detected. Computed tomography–guided aspiration of the pericardial cyst yielded approximately 500 mL of purulent fluid that grew methicillinresistant Staphylococcus aureus. The most probable portal of entry for the bacteria was the ulcerated skin lesions on the extremities. Intravenous corticosteroids and vancomycin produced improvement, and the patient later underwent surgical removal of the cyst. Pericardial cysts are thin-walled mesothelial cell–lined structures that are remnants of embryological development of the pericardium. They usually present as a round, sharply demarcated opacity seen on chest radiography in an asymptomatic patient. Although pericardial cysts can be detected on echocardiography, the lesion usually is confirmed by computed tomography. Pericardial cysts are generally benign, filled with clear fluid, and most commonly located at the right cardiophrenic angle, although hilar and mediastinal locations are observed occasionally. It is important to differentiate pericardial cysts from neoplasms. Usually 2to 4-cm in diameter, some pericardial cysts are much larger, as in our patient. Rarely, they may be infected and necessitate treatment. Large cysts may require surgical excision.

A Pericardial Hydatid Cyst Masquerading as Acute Inferolateral Myocardial Infarction

A case of pericardial hydatid cyst adjacent to the inferoposterial wall of the left ventricle is reported. Significant ST segment elevations in leads D2, D3, aVF, V5, and V6 on surface electrocardiography and sudden onset of severe chest pain mimicked acute inferolateral myocardial infarction. However, cardiac catheterization and coronary angiography showed normal coronary arteries and normal left ventricular cavity. The ST segment elevation in the inferolateral leads disappeared a few days after surgical resection of the cyst. Cardiac hydatid cyst should be considered in the differential diagnosis of patients with angina-like chest pain in endemic areas.

Dispnéia por compressão de estruturas mediastinais por cisto pericárdico

A case of a 65-year-old patient, showing dyspnea to strains and right side pain as main symptoms of an approximately 8 cm cyst in the pericardium. The physical, biochemical and electrocardiographic examinations did not evince any changes. The results from the thoracic radiography, CT scan and echocardiogram suggested pericardial cyst. Based on those clinical evidences, the patient was submitted to a thoracotomy in the right side thoracic region and a complete excision of the mediastinal mass was performed, with complete remission of the symptoms.

Cardiac herniation after resection of pericardial thymic cyst

Cardiac herniation following pericardial resection is a rare and potentially fatal complication. We present a case of a cardiac herniation after excision of pericardial thymic cyst. The patient had cardiac arrest one hour after surgery. Re-thoracotomy in the high dependency care unit, and reduction of cardiac herniation were done. There was no case report in the literature of cardiac herniation after excision of pericardial tumor.

Videoscopic Resection of a Giant Symptomatic Pericardial Cyst: Case Report

A 47-year-old woman presented with shortness of breath, chest discomfort, and hoarseness. She was found to have an enlarged cardiac silhouette on plain chest radiography. Computed tomographic scan and magnetic resonance imaging were diagnostic of a giant pericardial cyst. The patient underwent successful videoscopic removal of the cyst with complete resolution of her symptoms.

Pathologic Quiz Case: Large Cardiac Mass in a 24-Year-Old Woman

Pathologic Quiz Case: Large Cardiac Mass in a 24-Year-Old Woman

Cardiac Varix in Relation to Right Atrial Free Wall Presenting as a Mass Compressing the Right Atrium and Mimicking a Pericardial Cyst

Cardiac varix is a rare entity. It is generally small and is in relation to the interatrial septum, often mistaken as cardiac myxoma. A 19-year-old girl, on evaluation of respiratory infection, was found to have a mass compressing the right atrium. Computed tomographic scan and magnetic resonance imaging suggested a differential diagnosis of pericardial cyst or hydatid cyst. Peroperatively, a large (8 × 6.5 × 5.5 cm) cystic lesion in relation to the right atrial free wall was found. The histopathology of the resected mass revealed it to be a cardiac varix. The case is notable for its large size and its location in relation to the right atrial free wall.

Pulmonary artery aneurysm

No abstract available.

Infrasternal mediastinoscopic surgery for anterior mediastinal masses.

Infrasternal mediastinoscopic surgery is a new alternative to the thoracoscopic approach for patients with anterior mediastinal masses. We applied this technique to 18 thymectomies, one thymomectomy, and one cystectomy in a total of 20 patients with anterior mediastinal masses and then assessed the surgical results. Infrasternal mediastinoscopic surgery was accomplished in 18 of the 20 patients (90%). The pathological diagnoses included 13 Masaoka stage I thymomas, one stage II thymoma, two stage III thymomas, one thymic cyst, one pericardial cyst, one thymic granuloma, and one mature teratoma. Two patients with stage III thymoma required conversion to sternotomy, one for invasion into the innominate vein and the other for invasion into the pericardium. There was no surgically related mortality or complications in any patients. Infrasternal mediastinoscopic surgery is safe and feasible for stage I thymoma and other benign tumors in the anterior mediastinum.

Computed Tomography and Magnetic Resonance Imaging of the Pericardium: Anatomy and Pathology

The purpose of this article is to review the characteristics of computed tomography (CT) and magnetic resonance imaging (MRI) of the pericardium and pericardial diseases. Because patients with pericardial diseases usually present with nonspecific symptoms, these diseases may not be detected until they have reached an advanced stage. It is therefore important to distinguish between normal pericardial structure and disease. Multiplanar reconstruction images of CT and MRI are useful for evaluating faint changes of the pericardium. The specific pericardial diseases described in this article include pericardial cyst, constrictive pericarditis, pericarditis with radiation pericarditis, postoperative pericardial hematoma, and cardiac tamponade due to a paracardiac mass (lymphoma).

Life-threatening respiratory distress in a neonate with a pericardial cyst.

Our case report details the clinical course and management of a neonate with acute life-threatening respiratory distress presenting soon after birth. She needed intubation and ventilation. A pericardial cyst was diagnosed after a CT scan and 2D echo investigation. As a temporizing procedure the fluid was tapped and the child was electively operated. Postoperatively she made an uneventful and complete recovery. We have reviewed the literature for this rare and often asymptomatic lesion.

Detection of retained surgical sponge by transthoracic and transesophageal echocardiography

We describe an unusual case of extracardiac mass in a patient who was assymptomatic and submitted to an open-chest coronary artery bypass operation 5 years previously. Transthoracic and transesophageal echocardiography revealed a rounded mass compressing the right atrium with a thick contour surrounding a heterogeneous center, suggestive of foreign body. Magnetic resonance imaging identified the mass as a pericardial cyst. Operation revealed a fibrinous cyst encapsulating a sponge. This case illustrates the central role of echocardiography for the diagnosis and treatment of patients with suspected retained surgical sponges.

Pericardial cysts in children: surgical or conservative approach?

The authors present a case of an 11-year-old boy with a history of mild asthma and cough who underwent radiographic examination of the chest. The radiograph showed a round, discrete mass in the right cardiophrenic angle. The patient underwent thoracoscopic excision, and histologic examination found a unilocular, pericardial cyst. The possible causes of mediastinal masses and an argument for their surgical removal is presented.

Clinical Spectrum of Mediastinal Cysts

Congenital cysts of the mediastinum are an uncommon but important diagnostic group, representing 12 to 30% of all mediastinal masses. The purpose of this study was to review our institutional experience with congenital cysts of the mediastinum, emphasizing the clinical spectrum of the disease. Retrospective study. University hospital unit of general thoracic surgery. We retrospectively reviewed the records of 105 patients with cysts of the mediastinum (50 male and 55 female patients) who comprised 13.0% of mediastinal masses over the past 50 years. There were 10 pediatric patients (< 15 years old) and 95 adult patients. The prevalence of cysts in the adult populations was higher than that in children (14.1% vs 7.7%, p < 0.05). There were 47 bronchogenic cysts, 30 thymic cysts, 12 pericardial cysts, 7 pleural cysts, 4 esophageal duplications, 2 meningoceles, 1 thoracic duct cyst, and 2 others. MRI has become a useful tool for providing supplemental data in combination with CT. Overall, 38 patients (36.2%) with mediastinal cysts were symptomatic, including 39.2% with bronchogenic/esophageal cysts, 40% with thymic cysts, and 15.8% with pericardial/pleural cysts. One hundred patients had complete resection of their masses, 3 patients with pericardial diverticulum received a thoracoscopic fenestration without mortality, and 2 patients refused surgery. Early recognition of these relatively rare lesions would lead to immediate and appropriate surgical intervention. Early surgical intervention is also important because definitive histologic diagnosis can only be established by means of surgical extirpation.

Resection of a symptomatic pericardial cyst using the computer-enhanced Da Vinci™ surgical system

Traditionally, symptomatic pericardial cysts have been treated with thoracotomy and resection. More recently, video-assisted thoracoscopic procedures for pericardial cysts have been reported. We present the case of a 43-year-old man who was suffering from a symptomatic pericardial cyst. He underwent successful resection using a computer-enhanced robotic surgical system. This case is an example of the continued extension of robotic-assisted thoracic surgery.

Successful resection of an epicardial cyst

Cases of pericardial cyst have been reported by many authors, but the incidence of epicardial cyst originating directly from the epicardium in the pericardial cavity is extremely rare. A case of successful resection of epicardial cyst fortuitously discovered and diagnosed during cardiac operation is presented.

Value of transesophageal echocardiography in the diagnosis of compressive, atypically located pericardial cysts

Pericardial cysts are not common and rarely cause symptoms. We report 2 cases of atypically located pericardial cysts with hemodynamic compromise because of the direct compression of the pulmonary veins and the right pulmonary artery. In the first case, transesophageal echocardiography (TEE) disclosed a round cystic mass compressing the posterior wall of the right pulmonary artery, with blood flow reduction in the right lung. Because of the symptoms, the pericardial cyst was drained and the patient had an uneventful 1-year follow-up. In the second case, a large cystic mass compressing the left atrium and the pulmonary vein outflow was clearly shown by TEE in a patient with severe respiratory distress, cyanosis, and low blood pressure. A left ventricular thoracotomy was performed with the drainage of 500 mL serous fluid from the cyst. (J Am Soc Echocardiogr 2002;15:192-4.)