[Exertional dyspnea in the elderly - interpretation of an incidental finding]

A 93-year-old woman presented herself with subacute exertional dyspnea in our primary care setting. Imaging revealed a large pericardial cyst without echocardiographic evidence of hemodynamic compromise. Instead, findings were consistent with heart failure with preserved ejection fraction (HFpEF) in the context of hypertensive and valvular heart disease. Optimization of heart failure therapy, including initiation of an SGLT-2 inhibitor, led to clinical improvement. This case highlights the importance of integrating imaging findings into the overall clinical context in primary care.