Discussion Author: Tom Hash
A pericardial cyst is a congenital or acquired outpouching of parietal pericardium. They do not actually communicate with the pericardial cavity. (Pericardial diverticula communicate with the pericardial cavity). On chest radiographs, pericardial cysts appear as round, smooth densities usually within the right cardiophrenic angle abutting both the anterior chest wall and anterior aspect of the right hemidiaphragm. However, they can be found within the left cardiophrenic angle. Rarely they can be located well above the diaphragm, even within the superior mediastinum. There are case reports of pericardial cysts causing obstruction of the right middle lobe bronchus.
The cysts appear on computed tomography as smooth, low-attenuation (usually water-attenuation, occasionally higher if infected), unilocular lesions. They rarely have calcification.
The majority of patients with pericardial cysts are asymptomatic. However, the cysts can cause or be associated with chest pain (most commonly), dyspnea, persistent cough, or even paroxysmal atrial tachycardia. Symptom relief with complete excision is variable.
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