Alcohol ablation of pericardial cysts under pericardioscopical control

Pericardial cysts are rare. They are often asymptomatic mediastinal abnormalities, which are usually congenital. If symptomatic differential diagnosis can pose a diagnostic challenge since it has to consider the different causes of pericardial effusion including malignant forms. In 2 symptomatic female patients (aged 51 and 58 years) pericardiocentesis, pericardioscopy and pericardial fluid analysis confirmed the diagnosis of "spring water cysts." Pericardioscopy excluded protrusions, petechial bleeding, neovascularization or inflammation. Application of contrast media into the cyst confirmed by radiological control that no communication to the true pericardial sac was present. So after aspiration of the entire fluid, subsequent instillation of 10 ml ethanol for a few minutes was carried out to prevent recurrence of the cystic formation. The aspiration of the residual fluid under moderate suction demonstrated and 24-h clinical observation at the ICU completed the short intervention. All symptoms were relieved immediately in both patients. Recurrence was not observed in the follow-up.