Right Margin Research Articles

Pericardial cyst: An incidental finding.

Pericardial cysts are rare mediastinal cysts occurring with an incidence of 1 in 100,000. Characteristically, they occur along the right border of the heart. Their size varies from 1.0 cm to 15 cm, and they are often asymptomatic. Patients with symptoms usually have atypical chest pain. In the case reported here, a 37-year-old man complained of nonproductive cough. Chest x-ray film revealed a pericardial cyst that appeared as a large echolucent unilocular mass along the left border of the heart. Diagnosis was confirmed with the use of both computed tomography and transthoracic echocardiography.

Morphometrical Studies on the Exterior of the Heart of Pre-natal Non-descript Sheep

Background: Heart is the principal organ of circulatory system that pumps blood into the blood vessels and performs many vital functions. Its development before birth must be studied to safeguard the animal from the occurrence and consequences of various developmental anomalies. The detailed morphometry of different external parameters of heart especially in pre-natal sheep has not yet been reported.Methods: The foeti of sheep were divided into three age groups viz. early prenatal (up to 50 days), mid prenatal (51-100 days) and late prenatal (101 to 150 days) with fifteen animals in each age group. The various external parameters were recorded by using digital weighing machine, graduated measuring cylinder, digital Vernier’s calliper, non-stretchable nylon thread and graduated scale. The data recorded was statistically analysed by one way ANOVA with IBM SPSS 25.0 version software. Result: It was revealed that the average width of heart at its base was 4.82±0.22mm, 10.52±0.72mm and 21.57±1.03mm in early prenatal, mid prenatal and late prenatal stages respectively. The average dorso-ventral length of left ventricle of heart was measured as 4.82±0.14mm, 12.07±1.16mm and 25.58±0.88mm in early prenatal, mid prenatal and late prenatal stages respectively. The average distance between the left longitudinal groove and cranial border of heart at base was measured as 2.93±0.11mm, 6.38±0.39mm and 9.78±0.41mm in early prenatal, mid prenatal and late prenatal stages respectively. Similarly, the average distance between the right longitudinal groove and cranial border of heart at middle was measured as 1.96±0.09mm, 5.01±0.34mm and 8.31±0.50mm in early prenatal, mid prenatal and late prenatal stages respectively. All these parameters recorded showed significant (p ≤ 0.01) differences among the ages.

P1829 A middle aged man with pericardial cyst

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.

Imaging findings and complications of transcatheter interventional treatments via the inferior phrenic arteries in patients with hepatocellular carcinoma

ObjectiveTo evaluate imaging findings and complications from transcatheter interventional treatment of hepatocellular carcinoma via the inferior phrenic arteries. Material & Methods40 procedures in 25 patients (19 men; age range, 57–89 years) were retrospectively reviewed in this study. In all procedures, a micro-catheter was selectively inserted in the right inferior phrenic artery (n = 39) or left inferior phrenic artery (n = 1), and transcatheter arterial chemoembolization (n = 39) or transcatheter arterial embolization (n = 1) was performed. Imaging findings and patient charts were reviewed, and complications until time of discharge (median hospitalization period, 10.5 days; range, 3–21) were assessed. ResultsOn angiography or computed tomography during angiography, collateral circulation from the right inferior phrenic artery to the pulmonary artery was seen in eight of 39 procedures (seven patients, 28%). In seven of these procedures, Lipiodol deposition was seen on the unenhanced computed tomography just after the procedure (post-procedure computed tomography) in the pulmonary arteries or pleura, and in six procedures, the deposited Lipiodol was noted to have spread into adjacent lung fields on the one week follow-up computed tomography. Branches of the right inferior phrenic artery were seen along the right margin of the heart in 18 procedures, and Lipiodol deposition was seen along the right margin of the heart on post-procedure computed tomography in four procedures. Complications occurred in 21 of 39 procedures of right inferior phrenic artery intervention (53%): shoulder pain in 18 (45%), pleural effusion in 14 (35%), basal atelectasis in 11 (28%), paroxysmal atrial fibrillation in two (5%) and hemoptysis in one (3%). In 14 procedures (35.9%), pleural effusion was seen on follow-up computed tomography examinations, and 11 (28.2%) of these procedures also showed basal atelectasis. However, only three procedures with pleural effusion showed Lipiodol deposition on the post-procedure computed tomography. In one patient who underwent transcatheter arterial chemoembolization twice via the right inferior phrenic artery, atrial fibrillation occurred after both procedures. ConclusionsTranscatheter arterial chemoembolization or transcatheter arterial embolization via the inferior phrenic artery in patients with hepatocellular carcinoma was relatively safe. Shoulder pain was the most frequent complication, and required only conservative treatment. There was no clear connection between pleural effusion or basal atelectasis and collateral circulation from the right inferior phrenic artery to the pulmonary artery depicted on angiography, computed tomography during angiography or post-procedure computed tomography.

Application value of vessel-guided lymph node dissection in the laparoscopic radical gastrectomy (D2) of distal gastric cancer

Objective To investigate the application value of vessel-guided lymph node dissection (LND) in the laparoscopic distal gastrectomy (D2) of distal gastric cancer. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 157 patients who underwent laparoscopic distal gastrectomy (D2) of distal gastric cancer in the Affiliated Tumor Hospital of Shanxi Medical University from October 2012 to July 2015 were collected. Patients used vessel-guided LND that was divided into 4 steps: middle colic vessel-guided LND in the upper pyloric region, gastroduodenal artery-guided LND in the lower pyloric region, common hepatic artery-guided LND in the right upper margin of pancreas and splenic artery-guided LND in the left upper margin of pancreas. Observation indicators: (1) surgical and intraoperative situations, (2) postoperative pathological results, (3) follow-up situations. Follow-up using outpatient examination and telephone interview was performed to detect the postoperative 3-year survival rate up to June 2017. Measurement data with normal distribution were represented as ±s. The survival rate was calculated using the Kaplan-Meier method. Results (1) Surgical and intraoperative situations: 157 patients underwent successful laparoscopic distal gastrectomy (D2) of distal gastric cancer. Operation time, LND time, volume of intraoperative blood loss, time for initial out-of-bed activity, time to initial anal exsufflation and time of postoperative abdominal drainage-tube removal were (178±38)minutes, (61±27)minutes, (87±40)mL, (1.2±0.4)days, (2.8±1.3)days and (7.5±2.6)days, respectively. Of 157 patients, 10 with postoperative complications were improved by conservative treatment, including 5 with intestinal obstruction, 3 with anastomotic fistula and 2 dying of pulmonary infection; other patients didn′t have complications. Duration of hospital stay of 157 patients was (9±3)days. (2) Postoperative pathological results: total number of LND, numbers of LND in the lower pyloric region and in the upper margin of pancreas were 34.6±11.0, 4.8±2.1 and 12.3±4.7, respectively. TNM staging: 26, 33, 18, 24, 37 and 19 patients were respectively detected in stageⅠa, Ⅰb, Ⅱa, Ⅱb, Ⅲa and Ⅲb. (3) Follow-up situations: 142 of 157 patients were followed up for 6-56 months, with a median time of 27 months, and postoperative 3-year survival rate was 67.6%. Conclusion The vessel-guided LND is safe and effective in the laparoscopic distal gastrectomy (D2) of distal gastric cancer, and the operation steps can be simplified. Key words: Gastric neoplasms; Gastrectomy; Lymph node dissection; Vessel-guided; Laparoscopy

Clinical features and VPS33B mutations in a family affected by arthrogryposis, renal dysfunction, and cholestasis syndrome

Arthrogryposis, renal dysfunction, and cholestasis (ARC) syndrome is an autosomal recessive disorder caused by mutations in the VPS33B or VIPAS39 gene. The aim of this study was to investigate the clinical features and VPS33B gene mutations of an infant with ARC syndrome. A 47-day-old female infant was referred to the hospital with the complaint of jaundiced skin and sclera for 45 days and abnormal liver function for 39 days. The patient had been managed in different hospitals, but the therapeutic effects were unsatisfactory due to undetermined diagnosis. Physical examination showed jaundice of the skin and sclera. Systemic skin was dry with desquamation in the limbs and trunk. There were no positive signs on cardiopulmonary examination. The liver was palpable 2.0 cm under the right subcostal margin. The hips and knees were flexed, and the extension was limited, with low muscular tone in the four limbs. Biochemical analysis demonstrated raised serum total bile acids, bilirubin (predominantly conjugated bilirubin) and transaminases, but the γ-glutamyl transpeptidase level was normal. Routine urine test revealed increased glucose as well as red and white blood cells. On genetic analysis, the infant was proved to be homologous for a VPS33B mutation c.1594C>T(p.R532X). She was definitely diagnosed to have ARC syndrome. Symptomatic and supportive therapy was given, but no improvement was observed, and the infant finally died at 3 months and 29 days of life.

Clinical feature and genetic analysis of a family affected by congenital bile acid synthesis defect type 2: identification of 2 novel mutations in AKR1D1 gene

Congenital bile acid synthesis defect type 2 (CBAS2) is an autosomal recessive disorder caused by biallelic mutations of AKR1D1 gene, which encodes the Δ4-3-oxo-steroid 5β-reductase. Cholestatic jaundice is the main clinical manifestation, accompanied by malabsorption of fat and fat-soluble vitamins. This paper reported the clinical and genetic features of a CBAS2 patient definitely diagnosed by AKR1D1 genetic analysis. An 8-month-old male infant was referred to the hospital with the complaint of jaundiced skin and sclera over 7 months. On physical examination, growth retardation and malnutrition were discovered besides mild jaundice of the skin and sclera. The liver was palpable 8 cm below the right subcostal margin with medium texture, and the spleen was not enlarged. On liver function test, elevated levels of bilirubin (predominantly conjugated bilirubin) and transaminases were detected, but serum total bile acids and γ-glutamyl transpeptidase levels were within the normal ranges. Liver histopathologic analysis showed disorganized bile ducts, obvious multinucleated giant cells, significant cholestasis in hepatocytes, together with portal and interstitial fibrosis and lymphocytic infiltration. Via next generation sequencing analysis and Sanger sequencing confirmation, the infant proved to be a compound heterozygote of the AKR1D1 variants c.579+2delT and c.853C>T(p.Q285X), two novel mutations originated from his mother and father, respectively. CBAS2 was thus definitely diagnosed, and chenodeoxycholic acid was given orally. As a result, the abnormal liver function and hepatomegaly were improved gradually. On a follow-up 3 months later, a soft liver was palpable 2.5 cm below the right subcostal margin, and all liver function indices recovered to normal ranges.

Role of diagnostic laparoscopy in the treatment plan of gastric cancer

To assess the clinical value of the diagnostic laparoscopy in choosing treatment strategies for patients with gastric cancer. Retrospective analysis was performed on clinical and pathological data collected from 2 023 patients undergoing gastric cancer surgery in the Zhongshan Hospital of Fudan University from 2009 to 2014. All the patients were diagnosed as gastric cancer by endoscopic biopsy and staged by imaging examination before surgery. During the diagnostic laparoscopy procedure, a small periumbilical incision was made and a pneumoperitoneum with CO2 under 10-15 mmHg was established through a port. A 10 mm trocar was put in, and the camera was inserted. Two 5 mm trocars were put in two ports which located in midclavicular line two fingers under the left and right costal margin and then the instruments were inserted. A thorough inspection included ascites, the abdominal cavity, liver, diaphragm, spleen, greater omentum, colon, small intestine, mesentery, adnexa (female) and pelvic floor. If the tumor located at the posterior part of the stomach, the gastrocolic ligament was opened in order to look for carcinomatosis in the omental bursa. The accuracy rate of diagnostic laparoscopy in diagnosing adjacent organ invasion and intra-abdominal metastasis was calculated, and the rate of adjusting treatment plans after diagnostic laparoscopy was also calculated. There were 52.7%(1 067/2 023) of patients underwent diagnostic laparoscopy. The accuracy rate of diagnostic laparoscopy in evaluating adjacent organ invasion and intra-abdominal metastasis were 98.3%(1 049/1 067) and 98.1%(1 047/1 067) respectively. Besides, 14 patients with stage T4b and 32 with intra-abdominal metastasis, which were missed by imaging examination, were diagnosed by diagnostic laparoscopy. The treatment plans of 9.3% (99/1 067) of patients were changed after diagnostic laparoscopy, and 65 (6.1%) cases of non-therapeutic laparotomy were avoided. However, 18 cases of adjacent organ invasion and 20 cases of intra-abdominal metastasis were still missed by diagnostic laparoscopy, and 12 cases received non-therapeutic laparotomy. Diagnostic laparoscopy has considerable value in assessing adjacent organ invasion and intra-abdominal metastasis and has great clinical significance in making precise treatment plans.

Case report of unusual presentation of invasive thymoma in A 49 years old male

Invasive thymomas are rare tumours in the anterior mediastinum, representing 50% of anterior mediastinal masses and about 20-30% of all mediastinal tumours. They are of unknown etiology; about 50% of patients with thymomas are diagnosed incidentally with chest radiography. Thymoma is classified into different stages, which determine the prognosis and type of management, the standard primary treatment for these tumours is Thymectomy. This case study presents a 49 year-old man with unusual presentation of thymoma. On the non-contrast CT images, there was a welldefined heterogeneous anterior mediastinal mass adjacent to the right border of the heart. There was evidence of infiltrations into the anterior mediastinal fat but no mediastinal lymphadenopathy after contrast enhancement, the mass showed heterogeneous enhancement. CT guided trucut tissue biopsy and histological analysis of the mass showed that the tumour consists of neoplastic epithelial cells and non-neoplastic lymphocytes. The findings were consistent with invasive lymphoepithelial thymoma.

Not All Right-Sided Hearts Are the Same: The Importance of Identifying the Correct Diagnosis

Scimitar syndrome is characterized by an anomalous venous return with the characteristic chest roentgenogram (CxR) appearance of the anomalous vein draining into the inferior vena cava (IVC). This appears as a curvilinear opacity paralleling the right border of the heart resembling a curved sword or Scimitar. A 27-year-old white woman with a reported history of dextrocardia was admitted after a drug overdose. Examination demonstrated an obtunded woman with tachycardia and right sided heart sounds. Her CxR revealed a right sided heart image with two curvilinear opacities in the retrocardiac area. Chest computed tomography (CT) demonstrated that these opacities join to represent an anomalous vein draining into IVC. Furthermore, an anomalous systemic artery arising from the abdominal aorta was seen to supply the right lower lobe. The patient was eventually diagnosed with Scimitar syndrome. This syndrome affects 1–3 in 100,000 live births while nearly half of the patients remain asymptomatic with some initially being misdiagnosed as dextrocardia, such as in our case. Correctly diagnosing these patients is of paramount importance as some can develop severe pulmonary hypertension and right ventricular failure. In turn, close ongoing echocardiographic monitoring can help identify those that may benefit from surgical interventions to prevent them from developing these complications.

The initial stability of dental implant with horizontal plate (An in vitro study)

The Initial (primary) stability is one of the factors that play an important role in the success of the dental implants. The purpose of this study was to evaluate the initial stability of dental implant with horizontal plate by using five analytical tests: insertion torque, removal torque, resonance frequency analysis, push-in test and pull-out test. Materials and methods: Two different lengths of dental implants (5mm and 10mm) were tested in this study; each dental implant was 4mm in diameter with a square threads shape of 1mm pitch and 0.5mm depth. The crestal area was 4.2mm diameter contained a right angle margin circumferential ring while the apical area was tapered with two self-tapping grooves. In this study, the initial stability of dental implants' design was compared with initial stability of dental implants of the same dimensions and design that engage horizontal plates of 1.5mm thickness at the apical part. All dental implants were implanted into a solid rigid polyurethane foam blocks (artificial bone) of 0.48g/cm3 density and tested by the five initial stability tests. Each test was done with forty samples (twenty samples of 5mm length and twenty samples of 10mm length). Results: The statistical analysis was performed and the result showed that there was very highly significant difference between dental implants with the horizontal plates and dental implants without the horizontal plates of both 5mm and 10 mm lengths in four initial stability tests which were insertion torque, removal torque, push-in test and pull-out test. The statistical analysis of the resonance frequency analysis showed that there was non-significant difference between dental implants with the horizontal plates and dental implants without the horizontal plates of both lengths. Conclusion: These results implied that the dental implants with the horizontal plates had better primary stability compared with the dental implants without the horizontal plates confirming that the horizontal plates enhanced the primary stability of the dental implants.

Epidermoid cyst-a rare mediastinal mass.

A 39-year-old male was referred to our service for treatment of an asymptomatic mediastinal mass. The mass was detected on a routine pre-employment chest X-ray. CT scan showed a well-defined soft tissue mass measuring 7.5 × 5.5 × 5.3cm in close relation to the right border of the heart. A CT-guided biopsy proved to be inconclusive as necrotic tissue was obtained. At exploratory thoracotomy, a well-defined cyst was found attached to the right side of the pericardium. The cyst was totally excised and sent for histopathological examination which came back with a surprise diagnosis of epidermoid cyst.

A rare case of scimitar syndrome with horseshoe lung

Scimitar syndrome is a rarely seen congenital cardiopulmonary anomaly characterised by partial or complete anomalous pulmonary venous drainage into the inferior vena cava via an anomalous descending vein that runs parallel to the right border of the heart giving an appearance of a curved Turkish sword or scimitar on plain chest radiography. Clinicians should also be aware of other interesting cardiopulmonary anomalies that can be seen in association with scimitar syndrome. A 41-year-old female presented to the Chest Medicine Clinic (University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA) with lifelong worsening dyspnoea. As part …

English

CASE HISTORY: A 13 year old, obese girl weighing 76 Kg, with a height of 170 cm, who was asymptomatic till a week back, presented to the emergency department with a history of worsening abdominal pain, distension of abdomen, vomiting, and constipation on and off since 6 days. She had no significant past paediatric /medical /surgical or family history. She was admitted at a private hospital for these complaints for past two days and was referred to us. At presentation, she was dehydrated with BP of 100/68 mm hg, pulse rate of 94/min and Respiratory Rate of 24/min. Her abdomen was distended with diffuse tenderness, but no guarding or rigidity. Abdominal X-ray showed multiple air fluid levels, with dilated bowel loop in right upper quadrant, X-ray chest showed space occupying density supradiaphragmatic near the right border of heart. Lab investigations revealed anaemia, leucocytosis, and hypokalemia with hypochloraemia. CT scan revealed-3.6x2.9 cm (ML x AP) sized defect in the anterior diaphragmatic aspect in midline below the xiphisternum through which a approx 9 cm long loop of transverse colon and mesocolon was herniating in to the anterior mediastinum, causing widening of retrosternal space and compression effect and displacement of heart towards the left with atelectasis of Right Middle Lobe

Physical Signs in the Chest Part II

In this section some of the causes of the common physical signs are listed.Mediastinal shift.Mediastinal shift to one or other side is detected by deviation of the trachea or of the heart. Naturally the trachea is more often deviated be abnormalities in the upper part of the chest, or occupying the whole of one side of the chest, and the heart by abnormalities in the lower part of the chest. If the heart is deviated to the left the apex beat will be deviated to that side. If there is no obvious cause of enlargement of the heart one can provisionally assume, depending on the later detection of consistent physical signs, that deviation is due to mediastinal shift. It is less easy to be sure of deviation to the right, especially if the abnormal physical signs are present in the right lower zone and dullness at the right base makes it impossible to detect the right border of the heart. Inward deviation of the apex beat, unless it is gross, might be due to the patient having a relatively small heart. In this case initial impressions may have to confirmed by x-ray.

Studies on three diverse Frontonia species (Ciliophora, Peniculida), with brief notes on 14 marine or brackish congeners

Living observation and silver impregnation methods were used to investigate the morphology and infraciliature of three Fronto- nia ciliates (F. guangdongensis spec. nov., F. ocularis Bullington, 1939 and F. schaefferi Bullington, 1939) that were isolated from coastal waters of the South China Sea. Frontonia guangdongensis spec. nov. may be recognized by the combination of the following characteristics: cells about 160 × 35 μm in vivo; elongated body with right margin depressed in anterior third; length to width ratio 4:1 to 5:1; three or four vestibular and four or fi ve postoral kineties; peniculi 1 and 2 each with four rows of kineties, peniculus 3 with two rows; one contractile vacuole in mid-body region right of cell median; brackish water habitat. A key based on morphological data for fourteen marine or brack- ish water Frontonia species found in China is also provided. In addition, the small subunit (SSU) rDNA gene was sequenced for F. ocularis Bullington, 1939. Our phylogenetic analyses support the contention that the genus Frontonia is not monophyletic.

The Use of 2 Contrast Filling Patterns in the Diagnosis of a Giant Coronary Aneurysm

A 75-year-old woman was admitted for exertional dyspnea and chest pain that had been present for several months. She denied any past history of medical illness such as hypertension or diabetes, as well as any past history of significant trauma. On physical examination, no definite cardiac murmur was auscultated. A chest x-ray showed a bulging silhouette at the right border of the heart. Electrocardiographic findings showed no significant abnormalities. Two-dimensional echocardiography showed an abnormal echolucent large mass lesion at the right atrial side, suggesting an intraright atrial mass, pericardial cyst, or aneurysm. To determine the exact location of the mass and its relation to the right atrium, a contrast echocardiogram with intravenous agitated …

Absence of Left Coronary Artery in a Cadaveric Heart

The left coronary artery (LCA) normally originates from the left sinus of Valsalva. It is about ½ inch long and terminates by providing the left anterior descending (LAD) and circumflex (CX) arteries. The CX artery courses to the posterior surface of the heart where it terminates by anastomosing with the terminal part of the right coronary artery (RCA). In the present study we examined 104 cadaveric hearts and found one instance where the left coronary artery was missing. Its branches, the LAD and CX arteries were present but had separate origins at the sinus of Valsalva. The LAD appeared normal, however, the CX artery was abnormally large. It gave rise to the left marginal artery and terminated in the posterior interventricular sulcus as the posterior interventricular artery. The RCA after providing the right marginal artery, terminated at the right border of the heart and did not give rise to the posterior interventricular artery. Variations of coronary arteries are of great importance to surgeons involved in bypass and valve replacement surgeries. It has been reported that the LCA is the dominant artery in about 15% of the hearts. The incidence of separate origins of LAD and CX arteries is, however, very infrequent (0.09%).

Metals contents in two fishes of different feeding behaviour in the Lower Paraná River and Río de la Plata Estuary

Fil: Villar, Carlos. Consejo Nacional de Investigaciones Cientificas y Tecnicas. Centro Cientifico Tecnologico Conicet - La Plata. Instituto de Limnologia ; Argentina

Lymphocyte-rich pleural liposarcoma mimicking pericardial cyst

cyte-rich pleural liposarcoma, which mimicked a pericardial cyst on computed tomographic (CT) scan. Histopathologic examination revealed a recently described lymphocytic-rich variant, which might be mistaken for lymphoma.3 Clinical summary. A 78-year-old white man with a 40 pack-year history of smoking was seen for an asymptomatic opacity detected on a routine chest x-ray film. A chest radiograph 4 months earlier had shown no abnormalities. His medical history was significant for controlled atrial fibrillation, adult-onset diabetes mellitus, hypertension, and benign prostatic enlargement. He specifically denied cough, chest pain, and all constitutional symptoms. He reported dyspnea on moderate exertion, which had been stable for many months. His medications included lisinopril, metformin, digoxin, doxazosin mesylate, aspirin, and felodipine. On physical examination, vital signs were within normal limits and no adenopathy or jugular venous distention was detected. Examination of the chest was unremarkable, as was the rest of the physical examination. The chest radiograph revealed an opacity abutting the lower right border of the heart (Fig 1, A). A CT scan of the chest revealed a cystic opacity in the major fissure, apparently attached to the pericardium. The location and CT appearance were suggestive of a pericardial Liposarcomas are the second most common histologic type of soft tissue sarcomas.1 Common sites of involvement include the lower extremities and retroperitoneum. Primary intrathoracic liposarcomas are rare with a preference for the mediastinum.1 Very few cases of primary involvement of lung and pericardium have been reported, including only 9 cases of pleural liposarcomas.2 We review a unique case of lymphoLYMPHOCYTE-RICH PLEURAL LIPOSARCOMA MIMICKING PERICARDIAL CYST