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Complicated pericardial cyst: atypical anatomy and clinical course
G L Bava1, L Magliani, D Bertoli
1Department of Cardiovascular Surgery and Cardiology, Gaslini Pediatric Institute, Genoa, Italy.
Insights
A rare case of pericardial cyst causing cardiac tamponade in an 8-year-old boy highlights potential complications. The cyst
Area of Science:
- Cardiology and Pediatric Surgery
- Medical Imaging and Diagnostics
- Pathology and Histology
Background:
- Pericardial cysts are typically asymptomatic, often discovered incidentally.
- However, symptomatic presentations and severe complications like cardiac tamponade can occur.
Observation:
- An 8-year-old boy presented with chest pain, diagnosed with a large intrapericardial cyst (7.5 x 5.5 cm) and pericardial effusion.
- The patient's condition worsened, showing signs of cardiac tamponade, necessitating urgent surgical intervention.
- The cyst had a mobile vascular pedicle and inflammatory changes on its surface; aspirate was serosanguineous.
Findings:
- Histological examination confirmed a pericardial cyst with ischemia-related lesions.
- The cyst's unique vascular pedicle and the resulting ischemia were implicated in the cardiac tamponade.
Implications:
- This case suggests a novel pathogenetic mechanism involving vascular pedicle torsion leading to cyst ischemia and tamponade.
- Highlights the importance of considering rare complications even with typically benign conditions.
- Emphasizes the need for prompt evaluation and management of symptomatic pericardial cysts.
Abstract:
Pericardial cysts are usually detected by chance are are clinically silent in most cases. Nevertheless, symptoms and serious complications may occur. We describe a case of pericardial cyst diagnosed in an 8-year-old boy who was admitted with chest pain. Echocardiography revealed a mild to moderate pericardial effusion and a 7.5 x 5.5 cm intrapericardial echo-free lesion consistent with a pericardial cyst. Surgery was carried out 3 days afterward because of the patient's worsening condition, the progressive increase of pericardial effusion, and the onset of initial signs of cardiac tamponade. The cyst showed a long and easily movable vascular pedicle and inflammatory areas involving the pericardial surface. Like the pericardial effusion, the contents of the mass appeared as serosanguineous fluid on aspiration. Histologic examination confirmed the diagnosis of pericardial cyst and showed findings according to ischemia-related lesions of the cyst. The coexistence of pericardial cyst and cardiac tamponade is very unusual. The atypical anatomy and clinical course suggest a distinct and so far undescribed pathogenetic mechanism for this association: the torsion of a vascular pedicle and the subsequent development of ischemia-related lesions of the cyst.