대한흉부영상의학회 Weekly Chest Cases

Case No : 357 Date 2004-08-28

Courtesy of Jeong Joo Woo, M.D. / Eulji Hospital, Seoul, Korea
Age/Sex 45 / F
Chief ComplaintLower abdominal pain

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Diagnosis With Brief Discussion

Diagnosis: Pericardial cyst
Radiologic Findings: Chest PA and Lat. radiographs show elevation of the Rt side hemidiaphragm or subplumonic increased opacity with preservation of Rt costophrenic angle. Subpulmonic pleural effusion could be considered. But Rt.decubitus view shows well-defined mass attaching to mediastinum. CT scan shows cystic mass abutting to pericardium. Mass has very thin wall and shows molding nature on CPA.

Operation was done and large cystic mass in ant. mediastinum was found.

Pathologic examination(x200) revealed pericardial cyst lined by a single layer of mesothelial cells.
Brief Review: Pericardial cysts result from aberrations in the formation of coelomic cavities. The cyst walls are composed of connective tissue and a single layer of mesothelial cells, and they usually contain clear fluid. Pericardial cysts are invariably connected to the pericardium, but at surgery, only a few cases show visible communication with the pericardial sac. The interior is usually unilocular but is often trabeculated. The great majority are asymptomatic, but in surgical series symptoms such as chest pain, cough, and dyspnea may be present in up to one-third of patients. Most pericardial cysts arise in the anterior cardiophrenic angle, more frequently on the right side, but they can be seen as high as the pericardial recess at the level of the proximal aorta and pulmonary arteries. Occasionally, cysts are pedunculated.

Pericardial cysts are not always round; they may demonstrate different shapes. As referring to one of the reported case of the pericardial cysts, it appeared with elevation of the right diaphragm in healthy 25-yr-old woman, similar to this case. Retrospectively, owing to previous files, they could recognize the evolution of a pericardial cyst from the age of 13. At that time, it was much smaller and had a more typical pattern confined to the right cardiophrenic angle.
References: 1. Jeung M-Y, Gasser B, Gangi A, et al. Imaging of Cystic Masses of the Mediastinum. Radiographics 2002;22S79-S93

2. Parienty RA, Fontaine Y, Dufour G. A case report. Transformation of a pericardial cyst observed on long-term follow-up. J Comput Tomogr. 1984 Apr;8(2):125-8

3. Armstrong P, Wilson AG, Dee P, Hansell DM. Imaging of diseases of the chest, 3rd ed. Mosby, 2000;810-811
Keywords: Pericardium, Benign tumor,

No. of Applicants : 23

▶ Correct Answer : 8/23, 34.8%

- CIM Saint Dizier, France JC Leclerc
- Hangang SacredHeart Hospital, Korea Eil Seong Lee
- Hanyang University Hospital, Seoul, Korea Yo Won Choi
- Incheon Sarang Hospital, Korea Jung Hee Kim
- Mallinckrodt Institute of Radiology, USA Jin Mo Goo
- National Taiwan University Hospital, Taiwan Tan Che Kim
- Ondokuz Mayis University, Samsun, Turkey Cetin Celenk
- Social Security Hospital, Ankara, Turkey Meric Tuzun

▶ Semi-Correct Answer : 10/23, 43.5%

- Chonnam National University Hospital, Korea Sook Hee Heo
- Chonnam National University Hospital, Korea Yong-Ju Moon
- CHU Nancy-Brabois, France Denis Regent
- Dong-A University Hospital, Korea Ki-Nam Lee
- Homs National Hospital, Homs, Syria Rami Abou Zalaf
- Korea Univ Ansan Hopspital, Korea Je Bo-Kyung
- Marien Hospital, Hamm, Germany Davis Chiramel
- Seoul National University Hospital, Korea Chang Hyun Lee
- Sharma Clinic, Jaipur, India Dinesh Sharma
- Wonju Christian Hospital, Korea Woocheol Kwon

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 357 Date 2004-08-28

Discussion

No. of Applicants : 23