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Exertional Near-Syncope: Pericardial Cyst as a Cause of Left Ventricular Outflow Obstruction

Ryan Offman1, Joseph Skopek1

  • 1Michigan State University College of Osteopathic Medicine, Mercy Health - Muskegon, Department of Emergency Medicine, Muskegon, Michigan.

Clinical Practice and Cases in Emergency Medicine
|September 1, 2022
PubMed

Insights

A large pericardial cyst caused outflow obstruction in a healthy male, leading to near-syncope. Surgical resection resolved symptoms, highlighting cyst resection for symptomatic cases.

Area of Science:

  • Cardiology
  • Thoracic Surgery
  • Medical Diagnostics

Background:

  • Pericardial cysts are typically benign, fluid-filled sacs within the pericardium.
  • While often asymptomatic, large pericardial cysts can cause significant cardiac complications.
  • Left ventricular outflow obstruction is a rare but serious presentation of pericardial cysts.

Purpose of the Study:

  • To report a case of symptomatic left ventricular outflow obstruction caused by a large pericardial cyst.
  • To illustrate the diagnostic and therapeutic approach for such a condition.
  • To emphasize the potential for pericardial cysts to cause hemodynamic compromise.

Main Methods:

  • A 41-year-old male presented with recurrent exertional near-syncope.
  • Diagnostic workup revealed a large pericardial cyst compressing the left ventricle.
  • The patient underwent successful surgical resection of the pericardial cyst via cardiothoracic surgery.

Main Results:

  • The patient experienced complete resolution of near-syncope following cyst resection.
  • Hospital course was uneventful, with discharge seven days post-operation.
  • No recurrence of syncopal episodes was noted at follow-up.

Conclusions:

  • Pericardial cysts, though usually benign, can present with severe symptoms like outflow obstruction.
  • Surgical resection is an effective treatment for symptomatic pericardial cysts causing hemodynamic compromise.
  • While surveillance is an option for asymptomatic cases, symptomatic patients benefit from intervention.
Abstract

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