Pericardial cyst

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Kleine Perikardzyste 44M - CR pa und CT nativ axial - 001 - Annotation

Pericardial cysts are rare, benign cysts that occur within the pericardium, the double-walled sac containing the heart and the roots of the great vessels. These cysts are part of a broader category of lesions known as pericardial masses, which also includes tumors and other abnormal growths. Pericardial cysts are typically congenital, meaning they are present from birth, but their clinical manifestations can appear at any age.

Etiology and Pathogenesis

The exact cause of pericardial cysts remains largely unknown, but they are believed to arise from an aberration in the development of the pericardium during fetal life. These cysts are thought to result from the failure of one of the mesenchymal lacunae, which normally coalesce to form the pericardial sac, to obliterate. This leads to the formation of a fluid-filled cystic space within the pericardium.

Clinical Presentation

Most pericardial cysts are asymptomatic and are often discovered incidentally during imaging studies for unrelated reasons. When symptoms do occur, they may include chest pain, dyspnea (difficulty breathing), or palpitations, particularly if the cyst is large enough to compress adjacent structures such as the lung or heart. However, such symptoms are relatively rare.

Diagnosis

The diagnosis of a pericardial cyst typically involves imaging techniques. Echocardiography is often the first modality used, as it can easily detect the presence of cystic structures near the heart. For further evaluation, Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) can provide more detailed information about the cyst's size, location, and its relationship to nearby cardiac structures.

Treatment

The treatment for pericardial cysts depends on the size of the cyst and the presence or absence of symptoms. Asymptomatic, small cysts may require no treatment other than regular monitoring to observe for any changes in size or appearance. Symptomatic cysts, or those that are large and risk compressing heart or lung tissue, may necessitate surgical removal. Minimally invasive techniques, such as video-assisted thoracoscopic surgery (VATS), have become the preferred method for removing these cysts when surgery is indicated.

Prognosis

The prognosis for individuals with pericardial cysts is generally excellent, especially for those who are asymptomatic or who have undergone successful surgical removal. Complications are rare but can include cyst rupture, infection, or compression of cardiac structures leading to cardiac tamponade, a life-threatening condition.

Epidemiology

Pericardial cysts are rare, with an estimated incidence of 1 in 100,000 individuals. They account for approximately 7% of all mediastinal masses and are more commonly diagnosed in adults than in children.