Pericardial Cyst

Pericardial cyst is an abnormal dilatation of pericardium of the heart.

Types

Pericardial cyst can be simple or complex. Simple pericardial cyst are usually more prevalent with water, blood, or necrotic content. Complex cyst contains solid elements with septations. Sizes varies from 2 to 28 cm but they are usually less than 5 cm. Cyst wall is usually lined by mesothelial cells and located at the right pericardiophrenic angle.

Pericardial cysts can also be divided into congenital and acquired. In congenital cyst, lacunaes failed to merged embryologically. For acquired cysts, it could be due to inflammation, pseudocysts, trauma, post myocardial infection, or viral infection.

Clinical features

Clinical features include: pleuritic chest pain, dyspnea, palpitations, cough, pain on swallowing, fever, weight loss, and paroxysmal tachycardia.

Diagnosis

On chest x-ray, there will be abnormal tissue density or an isolated cystic shadow over the cardiophrenic angle. On transthoracic echocardiogram, there is lack of flow on the affected area on colour Doppler. On cardiac CT scan, there is non-enhancing, homogenous attenuation of the affected area. Cardiac CT is good for precise localisation of percardial anatomy. On cardiac magnetic resonance imaging, there is non-enhancing thin wall mass with low T1 signal and high T2 signal. Late gadolinium enhancement is negative.