대한흉부영상의학회 Weekly Chest Cases

Case No : 995 Date 2016-11-21

Courtesy of JeongJae Kim, KyungHee Lee / Seoul National University Bundang Hospital
Age/Sex 50 / M
Chief ComplaintIncidental finding on chest CT

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Diagnosis With Brief Discussion

Diagnosis: Wandering Pericardial Cyst
Radiologic Findings: First chest CT scan demonstrates low-attenuated cystic lesion with lobulated contour along the left cardiac border and left major fissure. A pedicle attaching the cystic lesion to the pericardium was suspected, adjacent to left ventricle.
Follow-up chest CT scan performed after 4 years showed interval migration of this cystic lesion within the left major fissure to the left paracardiac area without significant change in total volume.
Brief Review: Pericardial cysts are congenital lesions that arise as a result of aberrant formation of the somatic cavities. They are most commonly located in the right anterior cardiophrenic angle, with the next most frequent location being the left anterior cardiophrenic angle. Occasionally, a pericardial cyst may arise elsewhere in the mediastinum. These lesions are thought to be pedunculated, growing on a stalk away from the pericardium. They are mostly asymptomatic but may cause chest pain, cough, fever, and arrhythmias. Rare cases may cause erosion into vascular structures, pericarditis, obstruction of the right ventricular outflow tract, and pulmonary stenosis. Typically, pericardial cysts appear on CT images as well-defined, nonenhancing, homogeneous fluid-attenuation lesions that contain no internal septa. Occasionally, the cyst may contain proteinaceous or hemorrhagic fluid. Positional change of a chest lesion is thought to be virtually pathognomonic of a solitary fibrous tumor of the pleura, however, wandering pericardial cyst is another very rare but possible cause of a mobile lesion in the chest.
Please refer to: KSTR Imaging Conference 2015 Spring Case 1,
References: .
Keywords: Pericardium, Mediastinum, Congenital,

No. of Applicants : 92

▶ Correct Answer : 15/92, 16.3%

- NIMS,Hyderabad , India amit dadhania
- Kizawa Memorial Hospital , Japan Tomohiro Ando
- IRSA LA ROCHELLE , France, Metropolitan BIGOT
- Seoul national university , Korea (South) Boram Kim
- chungbuk national university hospital , Korea (South) soojung lee
- 異⑸ , Korea (South) 蹂
- 異⑸ , Korea (South) Junghwan Kim
- Chungbuk national university hospital , Korea (South) Miran Yeon
- Seoul national university hospital , Korea (South) Kumju Chae
- Konkuk University Medical Center , Korea (South) Yong Wonn Kwon
- Seoul National University Hospital , Korea (South) Sunkyung Jeon
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- CNUH , Korea (South) LEE JONG EUN
- SNUH , Korea (South) Juil Park
- 異⑸ , Korea (South) 瑜

▶ Correct Answer as Differential Diagnosis : 7/92, 7.6%

- Ishikawa Matto Central Hospital , Japan Manabu Akimoto
- Shiga University of Medical Science , Japan Akitoshi Inoue
- McGill University Health Center , Canada Alexandre Semionov
- Gifu University Hospital , Japan Yo Kaneko
- Chungbuk national university , Korea (South) Yong Kim
- Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
- Bundang CHA hospital , Korea (South) Dongjun Lee

▶ Semi-Correct Answer : 2/92, 2.2%

- King Abdulaziz University Hospital , Saudi Arabia Amr Ajlan
- Red Cross Society Himeji Hospital , Japan Soichiro Okamoto

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 995 Date 2016-11-21

Discussion

No. of Applicants : 92