A pericardial cyst is an uncommon benign dilatation of the pericardial sac surrounding the heart. It can lead to symptoms by compressing nearby structures, but is usually asymptomatic. Pericardial cysts can be congenital or acquired, and they are typically diagnosed with radiologic imaging. Management of pericardial cysts can include follow-up imaging, percutaneous aspiration, or surgical resection. Presentation
Pericardial cysts most often are asymptomatic, with 50 to 75% of patients experiencing no symptoms. The presentation of symptomatic cysts depends on the cyst location and effects on nearby structures, including the heart, lungs, and esophagus. Symptoms can include chest pain, cough, shortness of breath, palpitations, syncope, recurrent pneumonia, congestive heart failure, difficulty swallowing, and weight loss. Causes
Pericardial cysts can be congenital or acquired, with the majority being congenital. Congenital pericardial cysts happen due to an abnormality in the development of the pericardial sac that creates a bulge which is walled off to form a cyst. Acquired pericardial cysts can be caused by inflammation from surgery, pericarditis, trauma, echinococcosis, tuberculosis, metastasis, or hemodialysis. The inflammation can lead to a walled-off pocket of fluid that is a pericardial cyst. Diagnosis
Since pericardial cysts are often asymptomatic, the most common diagnosis is through incidental finding on a chest x-ray. When patients have symptoms, transthoracic echocardiogram is one of the first tests used to look for a pericardial cyst. CT or MRI may also be used to diagnose pericardial cysts. On CT and MRI a pericardial cyst will commonly appear as a round, fluid-filled structure surrounded by thin walls.
Pericardial cysts make up 6-7% of all mediastinal masses. They can present at any age, but are most commonly diagnosed between the third and fifth decade of life. Females and males have approximately equal incidences of pericardial cysts. History
Pericardial cysts were first reported on during autopsies in the 19th century by pathologists. As the field of radiology progressed, pericardial cysts could be identified in living patients. In 1931, the first surgical resection of a pericardial cyst was performed by Otto Pickhardt at Lenox Hill Hospital in New York using a thoracoscopy. In 1943, Greenfield and his colleagues coined the term "spring water cysts" for pericardial cysts since the cysts contain clear fluid. == References ==