Pericardial cysts are uncommon benign congenital anomaly of the anterior and middle mediastinum.
In most patients are asymptomatic and discovered incidentally although occasionally patients may present with chest pain and dyspnoea.
They are thought to often result from aberrations in the formation of coelomic cavities. They can occur as sequelae of previous pericarditis. The cyst wall is composed of connective tissue and a single layer of mesothelial cells, and usually contains clear fluid.
They are preferentially found in the right anterior cardiophrenic angle, but can be found almost anywhere adjacent to the heart. They occur more commonly on the right side (right cardio-phrenic angle being the commonest location).
Typically seen as a mass (added density) at the cardiophrenic sulcus. They can be of different shapes and are not always round. May change in shape and size with inspiration and position.
Usually appears as a well-defined, non-enhancing, low (water) attenuating, rounded mass next to the pericardium.
Morphology again can be variable. Internal septations may be present. Signal characteristic are those of fluid and include 4:
- T1: typically low signal (occasionally can be high signal in contains proteinaceous material)
- T2: high signal
- T1 C+ (Gd): no enhancement
Treatment and prognosis
They are benign lesions. Surgical resection or aspiration may be an aspiration for symptomatic selected cases 6-7.
As general differential on cross sectional imaging
On a chest radiograph also consider:
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