AMA Category 1 Credit for Physicians Only.
ASRT CME is not available.
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The patient has a pericardial cyst near the right atrium. Pericardial cysts occur at a rate
of 1:100,000. Pericardial cysts may occur from the failure of fusion of the
mesenchymal lacunae that form from the pericardial sac.
Pericardial cysts occur in the right and left cardiophrenic angle (70% and 22% respectively) and also anterior and posterior superior mediastinum. The cysts can be quite large and cause obstructive symptoms such as chest pain, cough, dyspnea, tamponade, sudden death, but, 75% cause no symptoms. Hemorrhage can occur inside the cyst. Cysts can rupture, and if the cyst ruptures into the pericardium, acute tamponade can occur. RVOT outflow obstruction, compression of cardiac chambers, erosion into adjacent structures, pulmonary artery stenosis, congestive heart failure, and atrial fibrillation are all possible complications.
The differential diagnosis is be:
Pezzano reported on 4 patients with pericardial cysts. He found that M-Mode was not helpful but 2D mode was helpful in locating the cyst and, in one case, found a teratoma along with the cyst. Butz reported a case where echocardiography was used to drain a large cyst. The cyst, in this case, was compressing lung tissue along with compression of the left ventricle. The cyst originated along the left cardiophrenic angle.
Treatment of pericardial cysts frequently involves observation with serial CT scans. Symptomatic or large cysts may be drained or resected. Anterior cysts can be drained by mediastinoscopy whereas, other cysts will require thoracotomy, thoracoscpy, or daVinciâ‚Äû¢ robotic assisted surgery.
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