A Rare Case of Incidental Pericardial Cyst

Case Report

A 38-year-old healthy female came for a yearly checkup at the outpatient department in which she underwent multiple blood tests, electrocardiogram, and echocardiography. All the blood tests were normal including electrocardiogram. But 2D echocardiogram showed a structurally normal heart with good left and right ventricular function; there was a pyramidal-shaped structure noticed just adjacent to the right atrium and right ventricle extending from the right border of the heart to midclavicular line in the 5th intercostal space in width, The depth extending from immediate retrosternal to 8 cm deep lying adjacent to right heart border. And vertically extending below from the diaphragm to 10 cm above the diaphragm (Figure 1). This cystic structure was avascular, confirmed with a CT scan (Figure 2). There was no diverticulum with the pericardium, which was confirmed with MRI (Figures 3 and 4). The female patient was reassured and advised to follow up on a regular basis.

Figure 1.

Abbreviations: PC, pericardial cystic; RA, right atrium; RV, right ventricle.

Figure 2.

Abbreviation: CE-CT, contrast enhanced computerized tomography.

Figure 3.

Abbreviation: cMRI, cardiac magnetic resonance imaging.

Figure 4.

Abbreviation: cMRI, cardiac magnetic resonance imaging.

Discussion

The cystic lesion adjacent to the heart is called a pericardial cyst. ¹ It is a rare entity with an incidence of 1 in 100,000 populations. ² Usually detected incidentally in the 3rd and 4th decade of life in asymptomatic patients (50%−70%). In 70% of cases, the cyst is found in the right cardiophrenic angle, 22% in the left, and 8% in the posterior or anterosuperior part of the mediastinum. ³ These cysts are usually harmless unless; they become so big as to compress structures such as the heart oesophagus, great vessels, and tracheal tree; ⁴ or rupture into pericardial sac causing tamponade; ⁵ or can cause pericarditis by infection of the cyst; ⁶ or sudden cardiac death.

The management of pericardial cysts depends on whether the patient is symptomatic or asymptomatic. All patients with symptoms should undergo surgery unless the patient is not fit for surgery. If some of the symptomatic patients have relief of symptoms then they can undergo percutaneous aspiration or ethanol sclerosis. If aspiration fails or there is a recurrence of cysts then they can undergo open heart surgery with cystectomy. The majority of the asymptomatic patients require conservative management.