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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 27, No 4, July/August 2016

e8

AFRICA

occur equally among men and women. The cysts range in size

from 2–3 cm, up to a maximum of 28 cm reported by Braude

et al.

8

In our case, the pericardial cyst measured 27

×

5

×

2 cm.

Most of these cases, including ours, are asymptomatic and are

diagnosed incidentally on chest X-ray.

4

The absence of symptoms

at diagnosis is a good prognostic sign. However, patients may be

admitted to a hospital with symptoms of chest discomfort or pain,

cough, dyspnoea, or palpitation due to compression of the heart.

9,10

Life-threatening complications, including cardiac tamponade,

obstruction of the right main stem bronchus, cyst infection

with cardiac or large vessel erosion and sudden death may be

encountered. Cardiac tamponade generally occurs due to intra-

pericardial rupture of the cyst. Spontaneous cyst rupture and

significant haemorrhage into the cysts have been reported, but

these have not been linked adversely to cyst size. Asymptomatic

cysts of this size are an unusual phenomenon.

11

Other reported

complications include right ventricular outflow tract obstruction,

pulmonary stenosis, atrial fibrillation, congestive heart failure,

and even sudden death after a stress test.

12-14

Pericardial cysts usually follow a benign course in the majority

of cases. There are no reports of malignant transformation.

For asymptomatic patients, conservative management with

short follow-up periods is recommended.

15

Treatment is needed

when symptoms or complications occur, and the management

of those patients should be performed in the light of clinical

characteristics. Indications for surgical resection of pericardial

cysts include large size, symptoms, cyst infection, patient request,

suspected malignancy, and prevention of complications.

10,14,16

Other treatment options for pericardial cysts include simple

observation, excision by thoracotomy, thoracoscopic surgical

removal, and percutaneous aspiration with injection of a

sclerosing agent. Although our patient was asymptomatic,

surgical excision was planned due to the large size of the cyst

and the concern that the mass was connected to the right atrium.

Conclusion

Conservative management with short follow-up periods is

recommended for asymptomatic patients with pericardial cysts.

However, surgery should be considered for patients who become

symptomatic and there is doubt about the paracardiac mass.

Our patient was unusual because of a rare giant pericardial cyst

mimicking a paracardiac mass.

This article was presented at the 10th International Congress: Update in

Cardiology and Cardiovascular Surgery (UCCVS) in March 2014.

References

1.

Losanoff JE, Richman BW, Curtis JJ, Jones JW. Cystic lesions of the

pericardium. Review of the literature and classification.

J Cardiovasc

Fig. 2.

Image of the excised cystic mass.

A

B

Fig. 1.

Axial (A), coronal (B) and sagittal (C) views of T2-weighted images in the paracardiac area showing a heterogeneous hyper-

intense mass (arrows).

A

B

C