Giant left-sided pleuropericardial cyst, mimicking a heart disease

Abstract

Mediastinal cysts (MC) mainly have an embryonic origin, are benign and frequently discovered thanks to tomodensitometry, sometimes by magnetic resonance imaging. Rarely symptomatic, excepted in cases of very large cysts, they are mainly pleuropericardic cysts (PPC) that represent 30% of MC Surgery is commonly performed by videothoracoscopy or by video-assisted mini-thoracotomy, mainly for PPC We report the case of a 62-year-old woman, smoker (30 packs years), who is hospitalized in Constanta Pneumology Hospital in June 2011 for slight shortness of breath, sweating, pain in the left hemi thorax, minor hemoptysis, recurrent. In her medical history, there are to be noticed a blood transfusion after hysterectomy for uterine fibroma (1995), arterial hypertension (2006). After admission, X-ray exam of the chest shows cardiomegaly and a few lung nodular lesions in the right upper lobe. An initial differential diagnosis includes congestive heart failure, dilated cardiomyopathy, valvular heart disease, left pleurisy, pericarditis, paracardiac tumor mass, tuberculosis +/- HIV. Following laboratory tests imaging (chest CT and ultrasound performed in June 26th 2011 and 27h) a possible pleuropericardic cyst was suspected. Exploratory thoracentesis was not performed and, a month later, in the Institute of Pulmonology "Marius Nasta" Bucharest, a left open thoracotomy revealed a cystic formation about 10 cm in diameter. Histopathologic exam confirmed the diagnosis of cyst pleuropericardic. The prognosis after surgery was favorable. As a feature of the case are worth mentioning: the large size of pericardial cyst at the upper limit of the data reported in the literature, which mimics cardiomegaly, the hemoptoic onset in a hypertensive patient, heavy smoker; the late suspicion of pleuropericardic cyst through pleural echographic exam; the atypical localization; the facilitated certain diagnosis by surgery and hystological exam; the favorable postoperative prognosis; and all morbidities cofound (Pulmonary Tuberculosis, bronchiectasis, COPD).