Echocardiography-Guided Percutaneous Aspiration of a Large Pericardial Cyst
A 42-year-old man was admitted with exertional breathlessness (New York Heart Association class II) and atypical chest pain. These symptoms were caused by a growing pericardial cyst situated in the left cardiophrenic angle, which had been diagnosed by chest radiography 17 years earlier (Figure 1A). Transthoracic echocardiography confirmed the presence of a large fluid-filled cyst within the pericardial space and excluded any compression of the left ventricular free wall by the cyst (Figure 2). Magnetic resonance imaging revealed a giant pericardial cyst (15×8×5 cm) in the left cardiophrenic angle with contact on the lateral thoracic wall (Figure 3).
We proceeded to drain the pericardial cyst without complications by positioning the Seldinger needle, introducing a 5F pigtail catheter into the cyst under permanent ultrasound guidance, and checking its correct position by injection of an echocardiographic contrast agent (Levovist; Schering AG, Berlin, Germany; Figure 4A and 4B). Percutaneous aspiration of the complete cyst volume revealed 400 mL of a clear, serous fluid. After this procedure, radiography confirmed the complete evacuation of the cyst (Figure 1B). The patient remained asymptomatic, and the cyst had not recurred in a 3-year follow-up.
Pericardial cysts are very rare mediastinal abnormalities and are most often found in either cardiophrenic angle.1 A diagnosis of pericardial cyst is usually suspected after an abnormal chest radiograph is obtained. Clinicians should include pericardial cysts in the differential diagnosis of mediastinal masses. Life-threatening complications such as pericardial tamponade have been reported in association with pericardial cysts.1 Echocardiography-guided percutaneous aspiration should be considered as the first choice of treatment for symptomatic pericardial cysts.2