Atypically located pericardial cyst in a patient who underwent off-pump myocardial revascularization
Masahiko Ozaki1, Masanori Ogiwara, Nobuyuki Okamura
1Department of Cardiovascular Surgery, Showa General Hospital, Kodaira, Tokyo, Japan.
Insights
This case report details an unusual superior mediastinal pericardial cyst found during coronary artery bypass grafting surgery. The benign cyst was successfully resected, highlighting atypical presentations of these rare lesions.
Area of Science:
- Cardiology
- Thoracic Surgery
- Diagnostic Imaging
Background:
- Pericardial cysts are uncommon, typically benign mediastinal masses, usually found at the cardiophrenic angle.
- Surgical intervention for cardiac conditions may incidentally discover mediastinal abnormalities.
Observation:
- A 61-year-old male patient presented with acute myocardial infarction requiring coronary artery bypass grafting (CABG).
- Preoperative computed tomography identified a homogenous, water-density cystic lesion in the superior mediastinum, adjacent to major vascular structures.
- The cyst's atypical location and appearance posed a diagnostic challenge.
Findings:
- The pericardial cyst was located superiorly, between the ascending aorta and superior vena cava, anterior to the aorta.
- The cyst was resected en bloc during the cardiac surgery.
- Histopathological examination confirmed the lesion as a benign pericardial cyst.
Implications:
- This case underscores the importance of considering atypical presentations of pericardial cysts, even in the superior mediastinum.
- Simultaneous resection of incidentally found benign mediastinal cysts during cardiac surgery is feasible and safe.
- Improved preoperative imaging and surgical planning are crucial for managing complex cases involving cardiac procedures and mediastinal masses.
Abstract:
Pericardial cysts are rare benign mediastinal lesions and most commonly located at the cardiophrenic angle. We present a case of an atypically located pericardial cyst in a patient who underwent myocardial revascularization. A 61-year-old man with acute myocardial infarction was scheduled for coronary artery bypass grafting (CABG). Preoperative chest computed tomography revealed a homogenous cystic lesion in the superior mediastinum. The mass was located between the ascending aorta, the superior vena cava, and the left innominate vein. It was growing to the anterior of the aorta and to the right anterior paratracheal area. The density of the mass was close to that of water; thus, the contrast medium failed to enhance its visualization. A concomitant resection of the mass and the CABG was scheduled. After a medial sternotomy and bypass graft harvest, a median pericardectomy was performed. The surgeon found the cystic mass along the roof of the pericardium and located between the ascending aorta and superior vena cava. There was no adhesion between the mass and cardiovascular components. The mass was resected en bloc; therefore, off-pump CABG was completed. Histopathological examination of the resected specimen confirmed diagnosis of a pericardial cyst.
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