대한흉부영상의학회 Weekly Chest Cases

Case No : 479 Date 2007-01-01

Courtesy of Eun Ju Chun, M.D. / Seoul National Unoversity Hospital, Korea.
Age/Sex 51 / F
Chief ComplaintIncidecntally detected righ cardiophranic angle mass Breast cancer history

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Diagnosis With Brief Discussion

Diagnosis: Pericardial Diverticulum
Radiologic Findings: Initial CT on '05-10-19 showed an about 2cm liquid-filled lesion with regular margins at the right cardiophrenic angle except of left breast mass. In a second CT performed 2 months later, reduction of the size of the lesion was observed. And serial CT film ('06-5-23 & '06-12-18) revealed a change in size of the lesion.
Brief Review: Cystic lesions of the pericardium result from a failure in the fusion of one of the mesenchymal lacunae that normally concur to form the pericardial sac (1). Pericardial diverticula are observed when a communication with the pericardial space persists. They are usually located at the cardiophrenic angles, especially on the right side.

Most patients are usually asymptomatic. However, symptomatic lesions sometimes present with chest pain, which may be explained by a torsion of the diverticulum (2).

Its typical finding and differential point from pericardial cyst is a change in the size of the lesion. This could be explained by the communication with the pericardial space, which allows emptying of the diverticulum (3, 4).

Surgical treatment is indicated in symptomatic lesions or when differential diagnosis with malignant lesions needs to be established. Thoracoscopic surgery offers satisfactory treatment of such lesions.
References: 1. Lambert AVS. Etiology of thin-walled thoracic cysts. J Thorac Surg 1940; 10:1-7

2. Waterbolk TW, Henkenschke CA, Remmert DG, et al. Pericardial diverticulum with unusual symptomatology. Eur Respir J 1991:4:232-234

3. Carretta A, Negri G, Pansera M. et al. Thoracoscopic treatment of a pericardial diverticulum. Surg Endosc 2003;17:158

4. Sechtem U, Tscholakoff D, Higgins CB. MRI of the abnormal pericardium. AJR Am J Roentgenol 1986;147:245-252
Keywords: Pericardium, Congenital,

No. of Applicants : 36

▶ Semi-Correct Answer : 29/36, 80.6%

- Pgimer, Chandigarh, India Ram Prakash Galwa
- Inje University Ilsan Paik Hospital, Korea Bae Geun Oh
- University Of Ulsan, Seoul Asan Hospital, Korea Jin Seong Lee
- Annecy Hospital, France Gilles Genin
- Hopital Jeanne De Flandres, Lille, France Benjamin Damarey
- Yonsei University, Severance Hospital, Korea Ahn, Sung Soo
- Yonsei University, Severance Hospital, Korea Eun Hye Yoo
- Annemasse, Polyclinique De Savoie, France Gay-Depassier Philippe
- Monaldi Hospital,Naples, Italy Gaetano Rea
- Hospital "Sotiria", Athens Greece Vasilios Tzilas
- Irsa, La Rochelle France Jean-Luc Bigot
- Nirman Hitech Diagnostic Centre, Mumbai, India Minal Seth
- Sweidaa National Hospital, Syria Marwan Al Chami
- Kaums, Kashan, Iran Ebrahim Razi
- Zulekha Hospital, Dubai Saurabh Khandelwal
- Zulekha Hospital, Dubai Julie Arora
- China Medical University Hospital,Taiwan Jun-Jun Yeh
- Ultra Care, Coimbatore, India Debabrata Das
- Chu Grenoble, France Bing Fabrice
- Dong-A University Hospital, Busan, Korea Ki Nam Lee
- Superspeciality Hospital, Nellore India Sunil Almale
- Shree Krishna Hospital, Karamsad, India Rakesh Yarlagadda
- Hangang Sacred Heart Hospital, Korea Eil Seong Lee
- IRSA, La Rochelle, France Denis Chabassiere
- Bollineni Superspeciality Hospital Nellore Jignesh Dubal
- E-Da Hospital, Taiwan Yu-Feng Wei
- Apollo Hospitals, Bangalore, India Rg Gopinath
- Homs National Hospital, Homs, Syria Rami Abou Zalaf
- Chung-Ang University Yongsan Hospital, Korea Jae Seung Seo

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 479 Date 2007-01-01

Discussion

No. of Applicants : 36