Cardiovascular Journal of Africa: Vol 27 No 4 (July/August 2016)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 4, July/August 2016 AFRICA e7
A rare giant pericardial cyst mimicking a paracardiac
mass
Hakan Akbayrak, Serkan Yildirim, Murat Simsek, Mehmet Oc
Abstract
Pericardial cysts are rare benign lesions of the thoracic cavity
and are mostly congenital anomalies. They are induced by an
incomplete coalescence of foetal lacunae during the develop-
ment of the pericardium. Pericardial cysts are usually uniloc-
ular, well marginated spherical or teardrop shaped and may
be attached to the pericardium directly or by a pedicle. Of all
pericardial cysts, 70 to 75% are located at the right cardio-
phrenic angle. We report a case that was incidentally diag-
nosed with only chest magnetic resonance imaging because
of a paracardiac mass. In order to prevent complications, the
giant pericardial cyst was excised outside of the pericardium
with median sternotomy.
Keywords: pericardial cyst, surgical treatment, sternotomy
Submitted 27/10/15, accepted 1/3/16
Published online 12/7/16
Cardiovasc J Afr 2016; 27: e7–e9
DOI: 10.5830/CVJA-2016-016
Pericardial cysts occur infrequently, with an incidence of one
in 100 000 individuals. Mostly they are congenital anomalies
but may also be acquired pericardial anomalies (e.g. post-
inflammatory, hydatid, neoplastic). Pericardial cysts are induced
by an incomplete coalescence of foetal lacunae during the
development of the pericardium.1,2
Pericardial cysts are usually unilocular, well marginated
spherical or teardrop shaped and may be attached to the
pericardium directly or by a pedicle.3 Of all pericardial cysts,
70 to 75% are located at the right cardiophrenic angle, and
the rest are on the left side of the mediastinum.4 They contain
clear serous fluid that is called ‘spring water’.5 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.6
Occasionally, pericardial cysts may alter cardiovascular
haemodynamics and/or pulmonary expansion, producing
signs and symptoms mimicking tricuspid stenosis, pulmonary
stenosis or constrictive pericarditis.7 Pericardial cysts occur most
frequently in the third or fourth decade of life and the incidence
of cases is equal in men and women. 8
We report on a patient with an extremely large pericardial
cyst that was connected to the right atrium. In order to prevent
complications, it was excised outside the pericardium with
median sternotomy.
Case report
A 48-year-old man presented with a dry cough. He was
incidentally diagnosed with a paracardiac mass with chest
magnetic resonance imaging and referred to our hospital. In
the right thoracic cavity, there was a heterogenous hyper-intense
mass, which seemed to be connected with the right atrium (Fig.
1). The mass extended from the superior to the inferior vena
cavae, outside the pericardium, in the right thoracic cavity.
On examination, his vital signs were as follows: pulse 96
beats/min, blood pressure 140/80 mmHg, body temperature
37.2°C, respiratory rate 18 /min and oxygen saturation on room
air was 97%. The white blood cell count was 7 000 cells/µl. His
respiratory and heart sounds were normal. The electrocardiogram
(ECG) and dobutamine stress echocardiography were normal.
Two-dimensional echocardiography from the subcostal view
showed a giant homogenous hypo-echoic mass that extended
from the superior to the inferior vena cavae.
Because of the concern that the mass was connected with
the right atrium, we operated on the patient with a median
sternotomy and excised the giant paracardiac cystic mass outside
the pericardium. The mass measured 27 × 5 × 2 cm (Fig. 2), was
well marginated and teardrop shaped, and was attached to the
right superior-lateral pericardium by a pedicle.
Pathological examination confirmed the diagnosis of a
fibrolipomatous cyst wall with no evidence of malignancy or
tissue other than pericardium. There were no other complications
in the postoperative period. Our patient was discharged on the
seventh day postoperatively.
Discussion
Pericardial cysts are rare, mostly benign, congenital lesions of
the mediastinum, but they may also be acquired pericardial
anomalies (e.g. post-inflammatory, hydatid, neoplastic).1,2 They
occur most frequently in the third or fourth decade of life, and
Department of Cardiovascular Surgery, Faculty of
Medicine, Selcuk University, Konya, Turkey
Hakan Akbayrak, MD,
Serkan Yildirim, MD
Murat Simsek, MD
Mehmet Oc, MD
Case Report