Successful Sternotomy to Remove an Enlarging Symptomatic Pericardial CystAlexander M. Kravets1, Matthew R. Schill2, Muhammad Faraz Masood21 Department of Surgery, Poznan University of Medical Sciences, Poznan, Poland. Electronic address: [email protected] Division of Cardiothoracic Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, Mo.Consent StatementWritten informed consent was obtained from the patient to publish this report in accordance with the journal’s patient consent policy.AbstractPericardial cysts (PCs) are rare. Most are discovered incidentally on radiographic imaging and are asymptomatic. Symptomatic patients may complain of chest pain and dyspnea. Delays in diagnosis and treatment are common. We report the case of a symptomatic 57-year-old female. CT and echocardiography confirmed the diagnosis and location, and the cyst was removed via sternotomy. A systematic approach is desired for the management of PCs.IntroductionCongenital pericardial cysts are fluid-filled, unilocular sacs lined by mesothelial cells. They typically form due to incomplete fusion of the pericardial sac during embryonic development [1]. Acquired pericardial cysts may result from trauma or inflammation of the pericardial sac. PCs occur in 1 in 100,000 patients and comprise 7% of all mediastinal masses [2]. They are most often found in the right cardiophrenic angle (70%) [1].Pericardial cysts were first described at autopsy in the mid-19th century [3]. Pericardial cysts are now most often diagnosed incidentally on radiographic imaging or echocardiography. Most patients are asymptomatic (75%) [2].Symptomatic patients typically complain of chest pain, dyspnea, and other symptoms resulting from the compression of structures adjacent to the pericardial sac. These symptoms may not correlate with physical activity. Worsening of symptoms at night has been reported in some patients. Nocturnal worsening of symptoms is gravity-dependent, resulting from a shift of fluid from the pericardium back into the pericardial sac [3].Patients presenting with symptoms typically experience delays in diagnosis and treatment. An increased awareness of this condition with respect to standardized follow-up and treatment may improve patient outcomes.We report the case of a 57-year-old female who presented with chronic symptoms resulting from a pericardial cyst in the left cardiophrenic angle.Case PresentationA 57-year-old female with a history of COPD and anxiety was referred to our clinic for evaluation of a pericardial cyst that had been incidentally diagnosed nearly two decades prior. She stated that approximately 3-4 years ago she began having hypertension and shortness of breath with activity. She had been recently evaluated for carotid artery disease, which was found to be negative for hemodynamically significant stenosis. She endorsed chest pain on her left side of her chest which could occur at any time. She also endorsed fatigue as well as progressive shortness of breath. She denied having lower extremity edema, orthopnea, PND, dizziness, or palpitations.On imaging, CT revealed a large pericardial cyst measuring 5 cm in diameter (Figure 1). The patient stated feeling as if she had an egg inside her chest. The cyst was confined to the left cardiophrenic angle and was adjacent to the fifth rib along the inner chest wall. Transthoracic echocardiogram was normal with slightly elevated BNP.
