St. Agnes Healthcare, Baltimore, MD, USA.
OBJECTIVE:
Pericardial cysts are benign congenital anomalies of the middle mediastinum. Pericardial cysts are formed from an incomplete coalescence of fetal lacunae forming the pericardium. They are typically asymptomatic and found incidentally. Giant pericardial cysts present via compression of mediastinal structures. METHODS:
Forty-one year old female followed by her primary care physician for a chronic cough is referred for a CT scan. A giant pericardial cyst (approximately 14 x 14 cm) is noted in the right mediastinum. A right thoracoscopic approach demonstrated a large cyst emanating from the pericardium. The cyst was resected utilizing blunt dissection along its anterior aspect. The stalk was excised with Electrocautery and an endovascular GIA. The patient's hospital course was unremarkable. There is complete resolution of her chronic cough.RESULTS:
CONCLUSIONS:
Pericardial cysts occur with an incidence of 1:100,000. Large pericardial cysts present with symptoms of mass effect. Treatment options include observation, aspiration and surgical excision. There are no current guidelines for length of observation for asymptomatic pericardial cysts; however this is the preferred avenue for high risk patients. Aspiration of a pericardial cyst results in a 33% recurrence rate at three years. Surgical resection is the only definitive treatment for pericardial cysts. The technology associated with thorascopic surgery has allowed cardiothoracic surgeons to diagnose and definitively treat giant pericardial cysts in a minimally invasive manner.
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