CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 6, November/December 2011
AFRICA
e3
Hynes
et al
. first used two-dimensional echocardiography to
diagnose a pericardial cyst.
5
Transoesophageal echocardiography
can be useful if transthoracic echocardiography is inadequate for
making the diagnosis.
12
However, no studies have been done to
ascertain the superiority of contrast CT over MRI and echocardi-
ography for diagnosis or follow up.
The treatment options for pericardial cysts include simple
observation, excision by thoracotomy, thoracoscopic surgical
removal, and percutaneous aspiration with the injection of a
sclerosing agent such as ethanol to decrease the likelihood of
cyst recurrence. The indications for resection of pericardial
cysts include large size, symptoms, patient concern, uncertain
malignant potential, and the prevention of complications.
13
Histologically, these cysts contain a single layer of mesothelial
cells, with the remainder of the wall composed of connective
tissue with collagen and elastic fibres.
14
Pericardial cysts can cause complications via the erosion of
adjacent structures, such as the right ventricle wall
15
or superior
vena cava.
16
Other complications include cyst rupture,
12
cardiac
tamponade,
17
mitral valve prolapse,
8
obstruction of the right
main-stem bronchus,
18
and even sudden death.
5
Treatment is usually required in symptomatic patients or in
those with an unclear diagnosis. In other patients, close follow
up is sufficient.
Conclusion
Pericardial cysts are rare, benign, mediastinal lesions. They
occur most frequently in the third or fourth decade of life and
equally among men and women. In order to prevent complica-
tions, pericardial cysts can be resected if the cyst is large, symp-
tomatic, or of uncertain malignant potential.
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