An Unusual Cause of Right Heart Failure: Hemorrhagic Pericardial Cyst Presenting as a Pericardial Mass and Constrictive Pericarditis

Abstract

Congenital pericardial cysts are very rare neoplasms of the middle mediastinum. We report a case of a young woman who was referred to the surgical department with abdominal pain. The ultrasound done showed moderate ascites and pleural effusion. Further evaluation with computed tomography (CT) chest revealed a calcified mass in the pericardium. Follow-up echocardiography showed an echogenic mass in the pericardium. Magnetic resonance imaging (MRI) revealed a hyperintense mass with a delayed enhancement of the contents with features of right heart failure. So, an emergency surgical resection was done that showed a large hemorrhagic mass with pultaceous material in the pericardial cavity. The pathological report confirmed the diagnosis of a hemorrhagic pericardial cyst with organized material.

Keywords

cardiac MRI - hemorrhagic pericardial mass - pericardial cyst

Ethical Standards

We declare that present study has been approved by the Institutional Ethics Committee and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that the patient gave informed consent prior to the study.

Declaration of Patient Consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Publication History

Article published online:
19 April 2022

• References

• 1 Feigin DS, Fenoglio JJ, McAllister HA, Madewell JE. Pericardial cysts. a radiologic-pathologic correlation and review. Radiology 1977; 125 (01) 15-20
• 2 Koshy T, Sinha PK, Misra S, Unnikrishnan M. Pericardial cyst. Ann Card Anaesth 2008; 11 (02) 129-130
• 3 Vlay SC, Hartman AR. Mechanical treatment of atrial fibrillation: removal of pericardial cyst by thoracoscopy. Am Heart J 1995; 129 (03) 616-618
• 4 Fredman CS, Parsons SR, Aquino TI, Hamilton WP. Sudden death after a stress test in a patient with a large pericardial cyst. Am Heart J 1994; 127 (4 Pt 1): 946-950
• 5 Chopra PS, Duke DJ, Pellett JR, Rahko PS. Pericardial cyst with partial erosion of the right ventricular wall. Ann Thorac Surg 1991; 51 (05) 840-841
• 6 Temizkan V, Onan B, Inan K, Ucak A, Yilmaz AT. Hemorrhage into a pericardial cyst and associated right ventricular compression after blunt chest trauma. Ann Thorac Surg 2010; 89 (04) 1292-1295
• 7 Mwita JC, Chipeta P, Mutagaywa R, Rugwizangoga B, Ussiri E. Pericardial cyst with right ventricular compression. Pan Afr Med J 2012; 12: 60
• 8 Shiraishi I, Yamagishi M, Kawakita A, Yamamoto Y, Hamaoka K. Acute cardiac tamponade caused by massive hemorrhage from pericardial cyst. Circulation 2000; 101 (19) E196-E197
• 9 Losanoff JE, Richman BW, Curtis JJ, Jones JW. Cystic lesions of the pericardium. Review of the literature and classification. J Cardiovasc Surg (Torino) 2003; 44 (05) 569-576
• 10 Maini R, Gadiraju TV, Jabbar A, Danrad R, Sweeney A. Cardiac MRI as a useful tool to differentiate tumor and thrombus. Int J Cardiovasc Imaging 2017; 33 (11) 1795-1796
• 11 Johnson EM, Gage KL, Feuerlein S, Jeong D. Cardiac magnetic resonance for the evaluation of suspected cardiac thrombus: Conventional and emerging techniques. J Vis Exp 2019; ••• (148)
• 12 Rinuncini M, Zuin M, Scaranello F. et al. Differentiation of cardiac thrombus from cardiac tumor combining cardiac MRI and 18F-FDG-PET/CT Imaging. Int J Cardiol 2016; 212: 94-96