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The Phrenic Nerves, Diaphragm and Pericardium.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
Usually these cysts cause no symptoms and increase in size only slowly. Most are found by chance, and the number in the population has been estimated as 1 per 10,000. These cysts are thinwalled and usually contain clear colourless fluid, hence the alternative name - 'spring-water cysts'. In most cases the fluid content may be confirmed with ultra-sound, particularly with those in the anterior cardio-phrenic angles. The cysts are usually ovoid or spherical in shape, though this may change with respiration or posture. Rarely a small portion of fat may be present between the cyst and the pericardium. On CT the contents mostly show Hounsfield numbers of 5 to 25, but occasionally they contain more viscid fluid up to 40 HU. CT is also useful for differentiating these cysts from thymic tissue in the upper anterior mediastinum. Malignant change within them has not to the author's knowledge been recorded. The cysts may be aspirated under fluoroscopic, ultrasound or CT control. Examples are shown in Illus. PERICARDIAL CYST.
Mediastinal tumours
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Fluid: There are several entities in the category of water attenuation or intensity in anterior mediastinal masses, including cysts arising from the thymus or pericardium, foregut duplication cysts, neurogenic tumours, abscesses, and lymphangiomas (particularly in children); many of these lesions may be neoplastic in nature (10). Cystic thin-walled lesions with no soft tissue nodules and with no internal separation can reliably be diagnosed as simple unilocular thymic cysts. Cystic lesions with soft tissue components may represent either multilocular thymic cyst or cystic thymoma (11). A thin-walled cyst situated in in the cardiophrenic angle can be reliably diagnosed as a pericardial cyst (12). It should be noted that in some circumstances, cysts may have a fluid attenuation above that accepted for water (more than 20HU) and thus MRI is required in these circumstances to confirm cystic from solid lesions (13).
Pericardial disease in the elderly
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
A pericardial cyst is usually a benign structural abnormality that is usually detected as an incidental finding on chest radiography, most commonly at the right cardiophrenic angle (5,6). Pericardial cysts can be congenital or acquired (often due to inflammation). Inflammatory cysts comprise pseudocysts as well as encapsulated and loculated pericardial effusions, caused by bacterial infection (usually tuberculosis in endemic areas), rheumatic heart disease, trauma, and cardiac surgery (5,6). Echinococcal cysts usually occur from ruptured hydatid cysts in the liver and lungs. Most cysts are small and asymptomatic, and need no specific treatment. However, some patients may experience symptoms like chest pain/discomfort and dyspnea. Echocardiography is the initial investigation of choice but cardiac CT or CMR are often required (5–7).
Thoracic benign cystic mesothelioma
Published in Acta Chirurgica Belgica, 2023
M. Furkan Sahin, Alkin Yazicioglu, Neslihan Inci Zengin, Erdal Yekeler
A 28-year-old female patient who presented with a complaint of cough was examined, and a mass was identified in the left hemithorax on the posterior-anterior chest radiography. A cystic mass of 8 × 6 × 6 cm in the left hemithorax adjacent to the pericardium was identified in the computed tomography of the thorax (Figure 1). The patient was diagnosed with a pericardial cyst and excision with VATS was planned. In the intraoperative management, we first aspirated the cystic fluid with a puncture needle to facilitate the excision of the large cystic lesion and to clearly define its boundaries. The cystic lesion was completely excised, together with the pericystic tissue and the adjacent paracardiac adipose tissue. En-bloc excision of the cystic mass with VATS was completed without complications. The patient's drain was removed on the second day following the surgery, and the patient was discharged on the fourth postoperative day.
Pediatric Bronchogenic Cysts: A Case Series of Six Patients Highlighting Diagnosis and Management
Published in Journal of Investigative Surgery, 2020
Jason E. Cohn, Kimberly Rethy, Rajeev Prasad, Judy Mae Pascasio, Katie Annunzio, Seth Zwillenberg
The differential diagnosis for bronchogenic cysts depends on their location in the body. A cystic neck mass can be a thyroglossal duct cyst, dermoid cyst, abscess, hemangioma, ranula, congenital midline cervical cleft, suspicious lymphoid hyperplasia, or a manifestation of sarcoidosis [11, 12] The working diagnosis for a cystic midline neck mass is abscess, thyroglossal duct cyst and bronchogenic cyst. A chest wall cyst differential should include epidermoid cyst, teratoma, lymphangioma, dermoid cyst, pilomatrixoma, in addition to bronchogenic cyst [13]. The working diagnosis for a cystic chest wall mass is dermoid cyst, teratoma, and bronchogenic cyst. A mediastinal cyst can be tuberculosis, foregut cyst, pericardial cyst, congenital cystic adenoid malformation, pulmonary sequestration, large B cell lymphoma, and enterogenic cyst [14]. The working diagnosis for a mediastinal cyst is foregut duplication cyst (including the bronchogenic and enterogenic variety) and pericardial cyst.
Epipericardial fat necrosis: an atypical cause of acute chest pain
Published in Acta Cardiologica, 2018
Luis Enrique Lezcano Gort, Imara Herrera Denis, María José Romero Castro, Zineb Kounka, David Chipayo Gonzales, José Javier Gómez Barrado
A 79-year-old woman presented to the hospital with a two-day history of left pleuritic chest pain. Her medical history was notable for permanent atrial fibrillation, and hypertensive cardiomyopathy with left bundle branch block. The patient´s ECG showed atrial fibrillation with rapid ventricular rate (120 bpm), and left bundle branch block not fulfilling Sgarbossa criteria. High-sensitive cardiac troponin T measurements were negative, D-dimer level was normal, and NT-proBNP was elevated (1929 pg/ml). Chest X-ray revealed pulmonary venous congestion, a left paracardiac opacity near the cardiophrenic angle (Figure 1(A,B), arrows), and a small ipsilateral pleural effusion. A pericardial cyst, and pericardial or pulmonary neoplasm were among the possible aetiologies of left paracardiac opacity. To clarify the diagnosis, a chest CT was performed. In the anterior left mediastinum, chest CT identified an ovoid, encapsulated, fat-containing mass, with thickening of the adjacent pericardium (Figure 1(C,D), arrows). CT findings were strongly suggestive of epipericardial fat necrosis, a rare self-limiting cause of acute chest pain. The patient responded well to analgesics, beta-blockers, and a short course of intravenous diuretics. Three days later the patient was discharged on analgesics. At 3-month follow-up the patient was free from any symptoms, with resolution of the CT findings.