An Incidental Finding of a Large Pericardial Cyst

Abstract

A pericardial cyst is a rare and benign cause of a mediastinal mass. They are frequently asymptomatic and are usually incidental findings on imaging. Symptoms may include persistent cough, atypical chest pain, dysphagia, and dyspnea. Diagnosis is usually established with the aid of imaging, including a chest x-ray, a computed tomography (CT) scan, and magnetic resonance imaging (MRI). Therapeutic options include surgical resection or aspiration for large and/or symptomatic cysts, whereas conservative management with routine follow-up is advised for small or asymptomatic cysts. We herein describe the case of a 48-year-old lady, who presented with clinical features suggestive of acute cholecystitis, with an incidental finding of a pericardial cyst, measuring approximately 10.1 cm x 8.7 cm x 10.7 cm. The patient underwent video-assisted thoracoscopic surgery (VATS) for excision of the pericardial cyst. She had an uneventful recovery and was discharged on the second post-operative day. At six months, there was no evidence of disease recurrence.

Keywords: congenital heart disease; congenital pericardial defect; incidental radiological finding; inflamed pericardial cyst; mediastinal cyst; mediastinal masses; mediastinal neoplasms; mediastinal tumors; pericardial cyst; video-assisted thoracoscopic surgery.

Figure 1. Posteroanterior (PA) chest x-ray showing a soft tissue-density consolidation in the right mid-and-lower hemithorax with obliteration of the right cardiac border (*).

Figure 2. A computed tomography (CT) scan of the chest showing a large, homogenous, well-circumscribed lesion in the right lower hemithorax, and abutting the right cardiac border (red arrow). (A, C, E) Lung window (demonstrating the lung parenchyma in detail, including the pulmonary vasculature) in axial, coronal, and sagittal views, respectively. (B, D, F) Mediastinal window (demonstrating the chest wall and pleura) in axial, coronal, and sagittal views, respectively.

Figure 3. A magnetic resonance imaging (MRI) scan of the chest with gadolinium enhancement. Axial T1-weighted fat-saturated (A) and T1-weighted (B) sequences at the same level showing a water-density lesion with thin walls, located at the cardiophrenic angle (yellow arrow). (C, D) T2-weighted and half-Fourier acquired single-shot turbo-spin echo (HASTE) sequences in axial view at the same level, respectively. (E, F) Coronal T1-weighted and T2-true fast imaging with steady-state-free precession (TRUFI) sequences, respectively. Sagittal T1-weighted (G) and T2-TRUFI (H) sequences.

Figure 4. Posteroanterior (PA) chest x-ray, performed on the sixth post-operative day, demonstrating clear lung fields bilaterally, with no obvious masses, nodules, consolidation or collapse visible. The previously seen soft tissue mass is no longer present. The heart was not enlarged and the cardiomediastinal contours were normal.