A rapidly enlarging giant pericardial cyst resected by video-assisted thoracoscopic surgery (VATS): A case report

Pericardial cysts are rare mediastinal masses of congenital etiology. Giant pericardial cysts measuring greater than 10 cm are even rarer. In a small proportion of cases, the natural history of pericardial cyst is one of continuous slow growth. Symptomatic pericardial cysts can be treated initially with percutaneous aspiration. Very large or complicated cysts are preferentially treated by open surgical excision. We present a case of a rapidly growing giant pericardial cyst in a 36-year-old male. The cyst was an overlooked incidental finding on a computed tomography scan of the abdomen and pelvis obtained for unrelated reasons seven years prior. At that time, it measured 4 × 2 × 1 cm. No further evaluation was carried out until he became symptomatic, at which time the cyst had a more than 2-fold increase in maximum diameter to a size of 11 × 10 × 6 cm. This resulted in compression of adjacent cardiac structures without hemodynamic sequalae. The cyst was completely excised via video-assisted thoracoscopic surgery, facilitated by initial intra-operative needle aspiration to reduce the size for safe mobilization. <Learning objective: Giant pericardial cysts measuring more than 10 cm in maximum diameter are extremely rare. A small proportion of pericardial cysts exhibit slow growth over time. Rapid growth should prompt consideration for cyst complication (infection, hemorrhage, malignant transformation) and need for excision. Computed tomography scan and magnetic resonance imaging are recommended at the time of initial diagnosis of pericardial cysts. Transthoracic echocardiography is suitable for serial follow up. Initial needle aspiration facilitates safe resection of giant pericardial cyst by video-assisted thoracoscopic surgery.>.