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.

[Pericardial cyst, a rare, minimally symptomatic lesion easy to treat]. / Kyste péricardique, une lésion peu fréquente, peu symptomatique mais facile à traiter.

A pericardial cyst is a rare and benign lesion, most commonly of congenital origin. A female patient of 35 years old was admitted to the emergency department of our institution, for non-irradiating thoracic pain associated with a dyspnea. A CT-Scan was performed, and a pericardial cyst of a large size was found. A surgical procedure through thoracoscopy was performed to enhance the symptomatology of the patient and to eradicate the cyst. The diagnosis of these lesions is most commonly sporadic after a radiography performed for other causes. Most of the time these lesions are asymptomatic (although thoracic pains, chronic cough and dyspnea amongst others may be observed). In case of suspicion (related to radiography or an eventual symptomatology) a thoracic scan is performed with a contrasting product for the confirmation and localization of the cyst. In addition to the diagnosis and the localization, it is best to perform a transthoracic ultrasound which enables a differential diagnosis with other lesions (lipoma, aortic aneurysm, solid tumour, and a left ventricle aneurysm etc.). A surgical treatment is recommended in symptomatic cases. In non-symptomatic cases, a transthoracic ultrasound is recommended.

Le kyste péricardique est une lésion rare, bénigne et le plus souvent congénitale. Nous rapportons le cas d'une patiente de 35 ans admise aux urgences de notre institution dans le cadre d'une douleur thoracique associée à une dyspnée. La réalisation d'un scanner thoracique permet de mettre en évidence un kyste péricardique d'une grande taille. Une intervention par chirurgie thoracoscopique vidéo-assistée a été réalisée afin de mettre à plat le kyste et, ainsi, d'améliorer la symptomatologie de la patiente. Le diagnostic de ces lésions est le plus souvent fait de manière fortuite, sur une radiographie réalisée pour une autre raison. Il s'agit généralement de lésions asymptomatiques bien que des douleurs thoraciques, une toux chronique ou encore une dyspnée sont retrouvées dans certains cas. En cas de suspicion, un scanner thoracique avec produit de contraste permet de confirmer et localiser précisément la lésion. Une échographie trans-thoracique permet, en plus, de réaliser un diagnostic différentiel avec d'autres lésions (lipome, anévrysme aortique, tumeur solide, anévrysme du ventricule gauche, etc…). En cas de lésion symptomatique, une prise en charge chirurgicale est recommandée. Dans les cas asymptomatiques, un suivi par échographie trans-thoracique est recommandé.

"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.

Isolated pericardial cystic Echinococcosis: A rare clinical presentation.

Isolated pericardial Hydatid cyst without involvement of other viscera is a rare condition with reported incidence of 0.5-2% of all cases of cystic echinococcosis even in the countries endemic for the disease. Hydatid disease is a major public health concern in the animal raising regions worldwide. Pericardial hydatid disease can be asymptomatic or present with varying symptoms from atypical chest pain, arrhythmias, rupture and tamponade to anaphylaxis. Early diagnosis and surgical treatment is necessary to prevent fatal complications. Here we report a case of symptomatic isolated pericardial hydatid cyst who presented with epigastric pain.

A HUGE PERICARDIAL CYST MIMICKING A FALSE LEFT DIAPHRAGMATIC PARALYSIS.

Pericardial cysts are infrequent mediastinal entities. They can mimic cardiac chamber enlargement, phrenic hernia, malignancy, bronchogenic cysts, pleurisy, dextrocardia. Diaphragmatic elevation can also be misdiagnosed in some cases. The reports about huge pericardial cyst mimicking the left diaphragmatic elevation (paralysis) are not common. The correct diagnosis of pericardial cyst can be difficult due to unremarkable complains and non-specific findings on chest radiography. In this report we have presented a rare clinical case described as the huge pericardial cyst mimicking a false left diaphragmatic paralysis. The combination of different radiological technics (CT-scans, barium esophago-gastrography etc.) are useful to correct preoperative diagnosis. Transthoracic (intercostal) accesses are the dominant to operate on patients with huge pericardial cysts.

Exophytic cavernous hemangioma arising from the right ventricle: Report of a rare case.

Cardiac hemangioma is relatively rare, accounting for approximately 1-3% of all primary heart tumors. This benign tumor may be an incidental lesion, but can also cause arrhythmias, pericardial effusion, congestive heart failure or outflow obstruction. We report a rare case with exophytic cardiac hemangioma arising from the right ventricle. Echocardiography showed an approximately 40 mm round protruding mass on the anterior wall of the right ventricle. Cardiovascular magnetic resonance demonstrated isointense and hyperintense signals on T1- and T2-weighted images, respectively. These imaging studies suggested a pericardial cyst. Perioperative findings indicated a globular, exophytic mass, vascular in nature, arising from the right ventricle. The lesion was resected directly, and the space left by defect in the right ventricular wall was covered with a bovine pericardial patch. Cardiac hemangiomas are generally endoluminal tumors, but we must keep in mind that the differential diagnoses include various pericardial lesions by medical images.

Benign lesions of the mediastinum: A review with emphasis on cytology and small biopsy specimens.

This review focuses on the diagnosis of select benign processes, ranging from reactive entities to heterotopic tissues to neoplasms, which may occur in the mediastinum. Currently, the mediastinum can be evaluated and biopsied with endoscopic procedures. Therefore, cytopathology specimens, fine needle aspirations, and small biopsies play an important role in the diagnosis of these lesions. In this review, an emphasis is given to relevant clinical presentations, histologic and cytologic findings, differential diagnoses, ancillary testing, and interpretation. Pitfalls are reviewed and discussed in each section. It is important for both surgical pathologists and cytopathologists to be familiar with these entities and their cytologic and histologic features that may be helpful in reaching a diagnosis.

A rare complication of a rare disease: Pericarditis due to ruptured pericardial cyst.

Pericardial cysts are considered rare incidental findings, which are generally asymptomatic in nature. Occasionally, patients may represent with chest discomfort, dyspnea, or palpitations. Pericarditis related to a ruptured pericardial cyst has not been previously reported in the literature. Here, we report the case of a 62-year-old man who developed acute pericarditis as a result of a ruptured enlarging pericardial cyst.

The ultrasound appearance of an unusual fetal pericardial cyst.

We describe the prenatal and postnatal sonographic findings and postnatal course in the first reported patient with a posterior mediastinal pericardial cyst. We then review and discuss current knowledge about the management of prenatally diagnosed cystic structures of the pericardium. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:149-151, 2018.

Hemorrhagic Pericardial Cyst Diagnosis Accelerated by Emergency Physician Echocardiography: A Case Report.

BACKGROUND: The differential diagnosis for chest pain in the emergency department is broad and includes both benign and life-threatening conditions-with pericardial cyst as a rare example. Emergency physician-performed point-of-care focused cardiac ultrasound (FOCUS) is increasingly recognized as a useful modality in the evaluation of patients with chest pain. CASE REPORT: We report a case of hemorrhagic pericardial cyst in a young woman presenting with chest pain in which findings on FOCUS contradicted findings on chest x-ray study and thus, accelerated diagnosis and definitive treatment. We also comment on epidemiology, pathophysiology, clinical presentation, diagnosis, and management of this uncommon, potentially fatal cause of chest pain. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case report aims to bring an uncommon case to the attention of emergency providers and emphasize the importance of facility with FOCUS. Although definitive diagnosis and management were not accomplished at the bedside in this case, an abnormal finding on FOCUS prompted further investigation and timely treatment.

A large pericardial cyst compressing the left atrium presenting as a pericardiopleural efussion.

Pericardial cysts are rare congenital abnormalities with a reported incidence rate of 1:100,000, accounting for about 7.6% of all mediastinal masses. These cysts frequently occur in the right cardiophrenic angle and their diagnosis is usually suspected after an abnormal chest X-ray is obtained. Herein, we present a case of pericardial cyst compressing the left atrium complicated by a pericardial effusion and pleural effusion in a 62 year-old man with chest discomfort and dyspnoea. After the pericardial cyst was surgically removed, the histopathological examination revealed an inflamed pericardial cyst lined with mesothelial cells.

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.

Ventricular tachycardia caused by mesothelial cyst.

A 27 year-old- lady was evaluated due to recurrent ventricular tachycardia. After performing echocardiography and cardiac MRI, she was found to have large pericardial cyst. Pathologic examination confirmed it as mesothelial pericardial cyst. Up to our knowledge it is the first presentation of simple pericardial cyst as ventricular a tachycardia.

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.

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.

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.