title: Right mesothelial pericardial cyst determining intractable atrial arrhythmias.
abstract: Pericardial cysts are intrathoracic lesions usually considered to be congenital and less frequently to be acquired. They are normally found incidentally upon chest radiography, computed tomography (CT)-scan or echocardiography. They are usually asymptomatic and have a benign behavior although sometimes they can cause clinical symptoms and diagnosis can be uncertain. We present, herein, the case of a 51-year-old male with a history of atrial arrhythmia resistant to transcatheter ablation therapies with an accidental finding of a pericardial cyst adherent to the lateral wall of the right atrium at the emerging superior vena cava. The patient was studied with transesophageal echocardiography, CT-scan and cardiovascular magnetic resonance with the evidence of dimensional increasing of the cyst at seriate controls. Considering this, in the absence of a definitive diagnosis and suspecting a link between the mass and the arrhythmia, the cyst was surgically removed through median sternotomy, off-pump on a beating heart. Postoperative course was unremarkable. Histopathologic examination confirmed it was a mesothelial pericardial cyst. At 12 months of follow-up the patient is doing well and he is in sinus rhythm. In conclusion, we believe that, although the majority of pericardial cysts need only radiological and clinical follow-up, surgical resection should be performed when the patient is symptomatic and when diagnosis is uncertain.
authors.affiliation: Department of Cardiovascular Disease E Malan, Cardiac Surgery Unit, IRCCS Policlinico S Donato Hospital, Via Morandi 30, San Donato Milanese, Milan, Italy. tompunto@hotmail.com
authors.forename: Tommaso
authors.initials: T
authors.lastname: Generali
authors.forename: Andrea
authors.initials: A
authors.lastname: Garatti
authors.forename: Piervincenzo
authors.initials: P
authors.lastname: Gagliardotto
authors.forename: Alessandro
authors.initials: A
authors.lastname: Frigiola
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D001282:Atrial Flutter / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D017115:Catheter Ablation; D017548:Echocardiography, Transesophageal; D006801:Humans; D033162:Incidental Findings; D008279:Magnetic Resonance Imaging; D008297:Male; D008476:Mediastinal Cyst / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D008875:Middle Aged; D011237:Predictive Value of Tests; D056346:Sternotomy; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure