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Echocardiography-Guided Percutaneous Aspiration of a Large Pericardial Cyst

2007; Lippincott Williams & Wilkins; Volume: 116; Issue: 18 Linguagem: Inglês

10.1161/circulationaha.107.711903

1524-4539

Thomas Butz, Lothar Faber, Christoph Langer, Marcus Wiemer, Dieter Horstkotte, Cornelia Piper,

Vascular anomalies and interventions

HomeCirculationVol. 116, No. 18Echocardiography-Guided Percutaneous Aspiration of a Large Pericardial Cyst Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBEchocardiography-Guided Percutaneous Aspiration of a Large Pericardial Cyst Thomas Butz, MD, Lothar Faber, MD, Christoph Langer, MD, Marcus Wiemer, MD, Dieter Horstkotte, MD and Cornelia Piper, MD Thomas ButzThomas Butz From the Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany. , Lothar FaberLothar Faber From the Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany. , Christoph LangerChristoph Langer From the Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany. , Marcus WiemerMarcus Wiemer From the Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany. , Dieter HorstkotteDieter Horstkotte From the Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany. and Cornelia PiperCornelia Piper From the Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany. Originally published30 Oct 2007https://doi.org/10.1161/CIRCULATIONAHA.107.711903Circulation. 2007;116:e505–e507A 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). Download figureDownload PowerPointFigure 1. A, Radiograph showing the pericardial cyst in the left cardiophrenic angle; B, radiograph after percutaneous aspiration of the pericardial cyst, demonstrating complete evacuation of the cyst.Download figureDownload PowerPointFigure 2. Modified 4-chamber view showing the pericardial cyst (★) without compression of the left ventricle (LV). LA indicates left atrium; RA, right atrium; and RV, right ventricle.Download figureDownload PowerPointFigure 3. Magnetic resonance imaging (1.0 T, transverse plane, fast field echo) demonstrated a 15×8×5-cm pericardial cyst (★) in the left cardiophrenic angle with contact on the lateral wall. (Courtesy of Dr A. Graewingholt, Radiology "Alte Torgasse," Paderborn, Germany.)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. Download figureDownload PowerPointFigure 4. A and B, A pigtail catheter (arrow) was brought into the pericardial cyst after percutaneous puncture, and the correct position was checked by injection of an echocardiographic contrast agent (Levovist).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.2DisclosuresNone.FootnotesCorrespondence to Thomas Butz, MD, Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Georgstraße 11, 32545 Bad Oeynhausen, Germany. E-mail [email protected]References1 Patel J, Park C, Michaels J, Rosen S, Kort S. Pericardial cyst: case reports and a literature review. Echocardiography. 2004; 21: 269–272.CrossrefMedlineGoogle Scholar2 Sharma R, Harden S, Peebles C, Dawkins KD. Percutaneous aspiration of a pericardial cyst: an acceptable treatment for a rare disorder. Heart. 2007; 93: 22.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Liu J, LV Q, Wang J, Zhang L, Xie M and Yang Y (2021) Diagnostic value of echocardiography in paracardiac cystic lesions: 43 cases from one single medical center, The International Journal of Cardiovascular Imaging, 10.1007/s10554-021-02180-9, 37:6, (1961-1966), Online publication date: 1-Jun-2021. Khayata M, Alkharabsheh S, Shah N and Klein A (2019) Pericardial Cysts: a Contemporary Comprehensive Review, Current Cardiology Reports, 10.1007/s11886-019-1153-5, 21:7, Online publication date: 1-Jul-2019. Alkharabsheh S, Gentry III J, Khayata M, Gupta N, Schoenhagen P, Flamm S, Murthy S and Klein A (2019) Clinical Features, Natural History, and Management of Pericardial Cysts, The American Journal of Cardiology, 10.1016/j.amjcard.2018.09.009, 123:1, (159-163), Online publication date: 1-Jan-2019. Yip M and Walsh B (2017) Hemorrhagic Pericardial Cyst Diagnosis Accelerated by Emergency Physician Echocardiography: A Case Report, The Journal of Emergency Medicine, 10.1016/j.jemermed.2016.10.023, 52:4, (e105-e109), Online publication date: 1-Apr-2017. Parmar Y, Shah A, Poon M and Kronzon I (2017) Congenital Abnormalities of the Pericardium, Cardiology Clinics, 10.1016/j.ccl.2017.07.012, 35:4, (601-614), Online publication date: 1-Nov-2017. Bezgin T, Elveran A, Varol S, Doğan C, Karagöz A and Esen A (2013) Pericardial cystPerikardzyste, Herz, 10.1007/s00059-013-3933-9, 39:8, (1005-1007), Online publication date: 1-Dec-2014. Maisch B (2013) Alcohol ablation of pericardial cysts under pericardioscopical control, Heart Failure Reviews, 10.1007/s10741-013-9383-x, 18:3, (361-365), Online publication date: 1-May-2013. Najib M, Chaliki H, Raizada A, Ganji J, Panse P and Click R (2011) Symptomatic pericardial cyst: a case series, European Heart Journal - Cardiovascular Imaging, 10.1093/ejechocard/jer160, 12:11, (E43-E43), Online publication date: 1-Nov-2011., Online publication date: 1-Nov-2011. Kang D, Corpa M, Racy M, Baroni R, Engel F, Andrade Filho L and Bueno M (2010) Pleuropericardial cyst torsion: case report, Einstein (São Paulo), 10.1590/s1679-45082010rc937, 8:2, (228-231), Online publication date: 1-Jun-2010. Niknejad M and Amini B (2008) Pericardial cyst Radiopaedia.org, 10.53347/rID-1859 October 30, 2007Vol 116, Issue 18 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.107.711903PMID: 17967983 Originally publishedOctober 30, 2007 PDF download Advertisement SubjectsCatheter-Based Coronary and Valvular InterventionsEchocardiographyHeart FailurePericardial DiseaseTreatment