A case series: uniportal VATS excision of pericardial cysts in symptomatic patients.

BACKGROUND: Pericardial cysts are infrequent lesions. Most of these are asymptomatic and incidental findings during investigations for unrelated conditions. When they are symptomatic, they demonstrate most of the time a benign clinical course. Yet, treatment is sometimes necessary. Besides a (temporary) treatment as percutaneous aspiration, there is surgery as a definite treatment. The aim of the paper is to motivate the safety and efficacy of uniportal video assisted thoracoscopy (UVATS) for the excision of (giant) pericardial cysts and describe their (peri-)operative technique. METHODS: In this retrospective, single center-based case series, we report all cases with a pericardial cyst who underwent a surgical excision by uniportal VATS (UVATS) between March 2022 and April 2023. Detailed patient characteristics, operation details, hospital length of stay and follow-up data were collected. RESULTS: A total of 4 patients underwent excision of a pericardial cyst by UVATS. The follow-up ranged from 10 to 20 months. The mean diameter of the pericardial cyst was 124 mm. Median procedure time was 94 min. No per- and postoperative complications occurred. The median length of postoperative hospital stay was 2 days. All patients showed a clinically relevant improvement of the pre-operative symptoms. CONCLUSIONS: Uniportal VATS excision for pericardial cysts is a safe and effective surgical procedure with good outcomes on symptom relief. Though, future comparative studies are urged to elucidate its value among other treatment options.

An important finding for differential diagnosis in thymic cyst mimicking pericardial cyst: punctate calcification.

Mediastinal cysts are usually congenital but present in adulthood. A pericardial cyst is usually localized in the right cardiophrenic region. Thymic cysts are less common and are located in the cervical region or anterior mediastinal region. While thoracoscopic excision or aspiration can be applied in pericardial cysts, excision is recommended in thymic cysts. We present a case of a thymic cyst located in the localization of the pericardial cyst and radiologically containing wall punctate calcification.

A Recurrent Case of Mesothelial Pericardial Cyst.

This is a case of a 37-year-old female patient with past medical history of mitral valve prolapse and benign mesothelial pericardial cyst status post laparoscopic resection who presented to the emergency department with a chief complaint of right-sided sharp non-radiating chest pain due to recurrent case of benign mesothelial pericardial cyst. Though this is not a common pathology, it does overlap with common cardiovascular symptoms/conditions; not limited to but including chest pain, dyspnea, palpitations, pericardial effusions, infections and arrhythmias. It is crucial to have appropriate history and physical exam and appropriate evaluation to rule out pericardial cysts as well as their locations and their potential lethal mechanical implication on crucial nearby structures. This is significant in order to avoid uncommon but lethal cardiac complications in this condition such as cardiac arrhythmias, cardiac tamponade, right ventricular outflow tract and even sudden cardiac death.

Large Pericardial Cyst Mimicking Recurrent Unilateral Pleural Effusion on CT Scan: A Case Report and Literature Review.

Pericardial cysts are an uncommon, benign condition that can manifest with diverse clinical symptoms influenced by their size and position within the body. Detecting pericardial cysts typically relies on imaging studies for a conclusive diagnosis. Surgical removal remains the definitive treatment approach for addressing pericardial cysts. This case report presents the clinical course of a 56-year-old female with a known case of asthma, and rheumatoid arthritis (RA) which exhibited recurrent symptoms such as shortness of breath and cough with recurrent pleural effusion to be investigated for suspected empyema, encysted effusion, TB, or malignancy, leading to diagnostic challenges. Through a combination of reviewing the case's clinical history, imaging modalities, and diagnostic procedures, including serial computed tomography (CT) and x-rays, the accurate diagnosis of a pericardial cyst sized 4.4 cm x 10.5 cm x 6.2 cm was achieved. In this specific case, recurrent percutaneous pleural aspirations were attempted as a treatment approach for three years. However, despite these efforts, this method proved unsuccessful in effectively managing the patient's condition. Using minimally invasive techniques, video-assisted thoracoscopic surgery (VATS) proved valuable in providing effective diagnostic and therapeutic options with reduced invasiveness. Timely diagnosis, proper monitoring, and patient education contributed to the patient's overall recovery.

A haemorrhagic pericardial cyst compressing the right side of the heart: a case report.

Background: Pericardial cysts are rare and represent the third most common cystic mass of the mediastinum. The majority are asymptomatic and detected as incidental findings; however, they can be symptomatic and associated with life-threatening complications such as bronchial compression, congestive heart failure, cardiac tamponade, or even sudden death. Case summary: We present a rare case of a haemorrhagic pericardial cyst with subtotal compression of the right side of the heart. A symptomatic male patient was referred due to progressive dyspnoea, signs of congestive heart failure for four months, and a transthoracic echocardiogram showing subtotal compression of the right heart side; the diagnosis was confirmed with thoracic computer tomography imaging and was removed surgically. Discussion: Pericardial cysts are asymptomatic and benign in the majority of cases; however, they can be associated with life-threatening complications. Thus, regular follow-up is recommended, and in a minority of cases, minimal invasive intervention or surgery could be imperative.

Pericardial Cyst at an Unusual Location: The Role of CT Imaging.

The pericardial cyst is a benign, uncommon congenital cystic lesion of pericardial origin located in the anterior and middle mediastinum. Most commonly, pericardial cysts are located in the right anterior cardiophrenic angle. Computed tomography (CT) and magnetic resonance imaging (MRI) of the chest are the non-invasive imaging modalities for the diagnosis of the pericardial cyst. Here we present a case of a 55-year-old male who presented with coughing and chest pain for two weeks. A chest X-ray revealed a soft-tissue opacity mass in the left lower zone. A CT of the chest showed a fluid-density cystic lesion in close proximity to the pericardium, located along the left posterior cardiophrenic angle, an uncommon location for a pericardial cyst.

"Bronchogenic cyst impersonating a pericardial lesion": A case report.

A 32-year-old female presented with palpitations and chest discomfort. The patient had a history of pericardiotomy due to pericardial effusion. Multimodal imaging, including echocardiography, cardiac magnetic resonance (CMR), and coronary computed tomography angiography (CCTA) showed a single mass in the pericardium as the cause of the symptoms. Furthermore, its location and potential complications were accurately defined. The patient underwent a successful surgical resection of the pericardial cyst, microscopic histopathological examination was compatible with a bronchogenic cyst, a very rare congenital malformation. The article discusses the rarity of bronchogenic cysts in the pericardium and the importance of accurate diagnosis and appropriate treatment.

Three in one: A case presented with multiloculated thymic cyst, thymic Hodgkin lymphoma and pericardial cyst.

Multiloculated thymic cyst is a cystic reaction of medullary epithelium to inflammatory process. In most cases, the exact cause of the inflammation is not known. Hodgkin lymphoma and multiloculated thymic cyst coexistence is a rare condition and may cause significant diagnostic difficulties. Herein, we present a rare case who underwent surgery for multiloculated thymic cyst and was subsequently diagnosed with Hodgkin lymphoma and had a concurrent pericardial cyst.

Pericardial Cyst in Birt-Hogg-Dubé Syndrome: An Unexpected Discovery.

Birt-Hogg-Dubé syndrome (BHD) is a genetic disorder typically characterized by pulmonary cysts, cutaneous fibrofolliculomas, and renal tumors. We report a case of an 87-year-old male patient with a known diagnosis of BHD and a large pericardial cyst who presented to the emergency room with chest pain. BHD is classically associated with pulmonary cysts and not pericardial cysts. In this report, we highlight the potential of pericardial cysts to independently cause retrosternal pain resembling angina, while also mentioning that BHD too can cause chest pain through the rupture of a pulmonary cyst leading to spontaneous pneumothorax. In our case, coronary angiography revealed non-obstructive coronary arteries, so the cause of chest pain was attributed to myocardial infarction with non-obstructive coronary arteries (MINOCA). Atypical causes of chest pain should be considered, especially in patients with diagnosed genetic syndromes.

Unusual cause of mediastinal tumor: A case of calcified pericardial cyst.

Pericardial cysts are rare benign intrathoracic lesions, and calcified pericardial cysts are even more uncommon. Most pericardial cysts are asymptomatic, but patients may present with chest pain, dyspnea and any complications of pericardial effusion. We present a case of a left-sided calcified pericardial cyst, highlighting its rarity and symptoms in relation to its location.

Giant pericardial cyst, an unusual cause of right heart failure in an elderly patient with tuberculosis and HIV: A case report.

Pericardial cysts are rare mediastinal masses commonly asymptomatic and incidentally found on chest radiographs. Pericardial cysts may be acquired/inflammatory in origin and may be symptomatic. We present a case of 65-year-old male who presented with symptoms of right heart failure. Diagnosis of a giant pericardial cyst was made using imaging modalities such as chest X-ray, computed tomography scan, and echocardiography. Percutaneous cyst aspiration was done under echocardiography guidance. Radiologists and cardiothoracic surgeons need to understand the pathology of inflammatory/acquired pericardial cysts to include in their differential diagnosis of mediastinal masses.

An unusual site of a pericardial cyst in a child: A case report.

Pericardial cysts are rare congenital anomalies, often clinically silent and incidentally found on imaging. However, patients with pericardial cysts may present with chest pain, tachypnea, and, rarely, symptoms secondary to cardiac tamponade. Echocardiography (transthoracic or transesophageal) and chest computed tomography (CT) scan with contrast are diagnostic modalities of choice in patients with pericardial cysts. Conservative management is justified in asymptomatic patients, while a surgical approach is recommended in symptomatic patients. Here, we describe the case of a 12-year-old boy who underwent imaging during the coronavirus disease 2019 (COVID-19) pandemic and was incidentally found to have a pericardial cyst.

A 19-year-old woman with mature pericardial teratoma.

Mediastinal teratoma accounts for 10% of congenital teratoma and 7% of all childhood germ cell tumors. Subsequently, teratomas including intrapericardial or pericardial teratoma are extremely rare. A 19-year-old woman case admitted to Moewardi General Hospital in Surakarta, Indonesia, in June 2022 was reported with chest pain radiating to her back. Previously, the patient was treated with a tuberculosis regimen 2 months ago, because the CT results showed as tuberculosis mediastinal abscess. Therefore, the patient was referred to this hospital for further diagnosis. In this hospital, the CT was re-expertise with a result cystic lesion attached to the pericardial suggestive pericardial cyst. The patient later experienced tumor resection and was pathologically diagnosed with a mature pericardial teratoma.

Surgical Management of Pericardial Cysts: A Single-Center Retrospective Study.

Introduction Pericardial cysts (PCs) are infrequent, non-malignant, and congenital abnormalities. The identification and treatment of PCs remain a significant challenge, with limited research on surgical management. Methods We performed a retrospective study of patients with PCs who underwent surgical intervention at the First Affiliated Hospital of Xinjiang Medical University from February 2002 to December 2022. Results A total of 55 patients underwent surgery due to PCs during the study period. Thirty-one were females and 24 were males. The average age of the patients was 44.7 ± 12.9 (six to 63 years old). PCs were located in the right hemithorax in 50 (90.9%) patients and left hemithorax in five (9.1%) patients. Approach methods were video-assisted thoracoscopic surgery (VATS) in 43 (78.2%) cases; thoracotomy in 11 (20%) cases, and median sternotomy in one (1.8%) cases. The average postoperative hospitalization period was 5.6 days (two to 14 days). Three patients developed postoperative complications (two pleural effusion, one pneumonia), whereas no mortality was observed in any patient due to the operation. Forty-one patients (74.5%) were followed up for three months to eight years postoperatively, during which no recurrent cysts were detected. Conclusion In this single-center retrospective study, we demonstrated that pericardial cyst cure is an appropriate operation according to cyst characteristics. VATS has been shown to be highly effective and safe in patients with PCs, offering the advantage of reducing postoperative morbidity efficiently.

Successful management of complex haemorrhagic pericardial cyst with cirrhosis of liver: a case report.

Haemorrhagic pericardial cysts are rare and may be complicated by encasement of the heart, right heart failure and, rarely, cardiac cirrhosis. Surgical management of complicated cysts is challenging and has poor outcomes. We report a case of successful surgical management of a complicated pericardial cyst presenting with cardiac cirrhosis and the challenges associated with this condition.

A rapidly enlarging giant pericardial cyst resected by video-assisted thoracoscopic surgery (VATS): A case report.

Pericardial cysts are rare mediastinal masses of congenital etiology. Giant pericardial cysts measuring greater than 10 cm are even rarer. In a small proportion of cases, the natural history of pericardial cyst is one of continuous slow growth. Symptomatic pericardial cysts can be treated initially with percutaneous aspiration. Very large or complicated cysts are preferentially treated by open surgical excision. We present a case of a rapidly growing giant pericardial cyst in a 36-year-old male. The cyst was an overlooked incidental finding on a computed tomography scan of the abdomen and pelvis obtained for unrelated reasons seven years prior. At that time, it measured 4 × 2 × 1 cm. No further evaluation was carried out until he became symptomatic, at which time the cyst had a more than 2-fold increase in maximum diameter to a size of 11 × 10 × 6 cm. This resulted in compression of adjacent cardiac structures without hemodynamic sequalae. The cyst was completely excised via video-assisted thoracoscopic surgery, facilitated by initial intra-operative needle aspiration to reduce the size for safe mobilization. .

Pericardial Cyst, A Rare Incidental Finding in an Uncommon Location: A Case Report.

A pericardial cyst is one of the rare causes of mediastinal masses. Most of the cases are secondary to congenital incomplete fusion of the pericardial sac. More than two-thirds of the cases are present in the right cardiophrenic angle, and the left cardiophrenic angle is the second most common location. In our study, we illustrated an incidental finding of the pericardial cyst in a patient who presented with nonspecific symptoms and was found to have a left-sided cardiophrenic pericardial cyst, which is only found in about 20% of the cases. A CT scan and echocardiogram confirmed the diagnosis of a 4.39-centimeter cyst with no signs of complications like tamponade or pericarditis. As the patient's symptoms resolved, outpatient follow-up with serial echocardiogram was advised. Through this report, we aim to raise awareness of the importance of further investigation for nonspecific symptoms like atypical chest tightness and differentiating simple pericardial cysts from other pericardial lesions. Based on the symptoms, size, and compression effect of the cyst, management may vary from serial echocardiogram to aspiration or surgical resection.

An Unusual Cause of Right Heart Failure: Hemorrhagic Pericardial Cyst Presenting as a Pericardial Mass and Constrictive Pericarditis.

Congenital pericardial cysts are very rare neoplasms of the middle mediastinum. We report a case of a young woman who was referred to the surgical department with abdominal pain. The ultrasound done showed moderate ascites and pleural effusion. Further evaluation with computed tomography (CT) chest revealed a calcified mass in the pericardium. Follow-up echocardiography showed an echogenic mass in the pericardium. Magnetic resonance imaging (MRI) revealed a hyperintense mass with a delayed enhancement of the contents with features of right heart failure. So, an emergency surgical resection was done that showed a large hemorrhagic mass with pultaceous material in the pericardial cavity. The pathological report confirmed the diagnosis of a hemorrhagic pericardial cyst with organized material.

Pericardial cyst in a one-year-old boy with ventricular septal defect and patent ductus arteriosus.

BACKGROUND: Pericardial cysts are rare, with the most common etiology being congenital. Ventricular septal defect is the most common congenital heart disease in children. However, the combination of pericardial cyst, ventricular septal defect, and patent ductus arteriosus is extremely rare. CASE PRESENTATION: A one-year-old boy with ventricular septal defect and patent ductus arteriosus was planned for surgical correction. Intraoperatively, we made an additional diagnosis of a large pericardial cyst; and the cyst was excised along with ventricular septal defect closure and patent ductus arteriosus ligation. CONCLUSIONS: Pericardial cysts can sometimes be missed with transthoracic echocardiography. Excision of the cyst can safely be done during concomitant cardiac surgery.