From the Guidelines
Pericardial cysts are generally benign and mostly asymptomatic, but can cause symptoms such as chest discomfort, dyspnea, or palpitations due to cardiac compression, and their management depends on the presence of symptoms and the risk of complications. The clinical significance of a pericardial cyst lies in distinguishing it from other mediastinal masses and determining the appropriate management based on symptoms and risk of complications 1.
Key Characteristics of Pericardial Cysts
- They are rare mediastinal masses with an incidence of 1 in 100,000 patients 1.
- They represent 6% of mediastinal masses and 33% of mediastinal cysts 1.
- They are often found in either one of the cardiophrenic angles and may be uni- or multiloculated 1.
- Inflammatory cysts comprise pseudo-cyst as well as encapsulated or loculated pericardial effusions caused by rheumatic disorders, bacterial infection, trauma, or cardiac surgery 1.
Management of Pericardial Cysts
- The first treatment for symptomatic congenital and inflammatory cysts is percutaneous aspiration, possibly associated with ethanol sclerosis 1.
- If the diagnosis is not completely established by imaging or the cyst recurs after drainage, surgical resection may be necessary 1.
- For echinococcal cysts, percutaneous aspiration and instillation of ethanol or silver nitrate after pre-treatment with albendazole (800 mg/day for 4 weeks) has been proposed 1.
- Asymptomatic cysts can be managed with observation through periodic echocardiography or CT scans every 1-2 years to monitor for changes in size or characteristics.
Complications and Risks
- Complications of pericardial cysts, though rare, can include cyst rupture, cardiac compression, or infection.
- The risk of complications and the presence of symptoms should guide the management of pericardial cysts, with symptomatic cysts requiring intervention to prevent potential complications.
From the Research
Clinical Significance of Pericardial Cysts
- Pericardial cysts are intrathoracic lesions that are usually considered to be congenital and are often found incidentally upon chest radiography, computed tomography (CT)-scan, or echocardiography 2, 3, 4.
- They are typically asymptomatic and have a benign behavior, although they can sometimes cause clinical symptoms and diagnosis can be uncertain 2, 3, 4.
- The estimated incidence of pericardial cyst is 1:100,000, and they represent approximately 6% of all mediastinal masses 3.
Management of Pericardial Cysts
- The choice between surgical intervention and conservative follow-up is related mainly to the size and symptoms induced by the cyst 3.
- Surgical resection is indicated when pericardial cysts are huge, enlarging in size, or symptomatic 2, 3, 4.
- Morbidity and mortality risks following pericardial cyst excision are very low 3.
- Surgical treatment of pericardial cysts should be reserved for patients who have severe symptoms due to complications or when diagnosis is uncertain and malignancy is suspected 4.
Symptoms and Complications
- Patients with pericardial cysts can present with symptoms similar to acute chest pain or right-sided heart failure, or can be asymptomatic 3.
- Pericardial cysts can cause complications such as cardiac tamponade, which is a life-threatening condition 5.
- The coexistence of pericardial cyst and cardiac tamponade is very unusual, and the atypical anatomy and clinical course suggest a distinct pathogenetic mechanism for this association 5.
Diagnostic Challenges
- Pericardial cysts can be difficult to diagnose, and a high index of suspicion is essential for diagnosis 3.
- Computed tomography and echocardiography are useful diagnostic tools for pericardial cysts, but they may not always detect the cyst, especially if it is small or located in an unusual position 4.
- Histopathologic examination is necessary to confirm the diagnosis of pericardial cyst 2, 3, 4.