Introduction
Pericardial cysts are quite rare and most of them have no associated symptoms and are incidental findings. Nonetheless, symptoms, if present, include atypical chest pain, dyspnea, and persistent cough. They are typically found in the right cardiophrenic angle. Treatment options include surgical resection or percutaneous aspiration of the cyst. We report a multimodality imaging and management of a case of giant pericardial cyst associated with persistent cough.
Case
A 23-year-old male presented with symptoms of persistent cough. Chest radiography revealed a low-density mass adjacent to the right side of the heart. Transthoracic echocardiography showed a 7x9x9 cm size structure of liquid-density adjacent to the right side of the heart. Computed tomography supported the diagnosis a 7×9 cm of liquid-density, but did not clear about its neighborhood with the heart. Thereafter, cardiovascular magnetic resonance imaging (MRI) was performed and revealed a homogeneous mass located in the right paracardiac-paramediastinal region with high signal intensity on T2-weighted images low-to-intermediate signal intensity on T1-weighted images and no gadolinium enhancement, suggesting the diagnosis of a pericardial cyst with a benign nature. Also, cardiac MRI revealed that this cystic lesion lead to extrinsic compression to the distal segment of superior vena cava, right atrium and right ventricle basis. The patient underwent surgical excision (with VATS method) of the cystic lesion due to its huge size and extrinsic compression to the heart. Pathological examination showed that this pericardial cyst was a cystic thymoma (type B1) and there was no evidence of invasion. Patient was discharged in a good condition and free of symptoms on 3-month follow-up.
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