SESSION TITLE: Critical Care Student/Resident Case Report Posters III
SESSION TYPE: Student/Resident Case Report Poster
PRESENTED ON: Tuesday, October 27, 2015 at 01:30 PM - 02:30 PM
INTRODUCTION: Pericardial cysts are usually benign and do not require invasive therapy. We report a case of pericardial cyst causing respiratory failure that improved after surgical resection.
CASE PRESENTATION: An 84 year old female presented with complains of weakness. She was in hypercarbic respiratory failure associated with septic shock. Chest x-ray revealed elevation of the right hemi diaphragm with basilar atelectasis (Figure 1). Chest CT revealed a large right pericardial cyst (16*10 cms) with mass effect compressing the diaphragm and right lower lobe (Figure 2). Despite treatment for pneumonia she continues to exhibit hypercarbic respiratory failure with pH 7.245, PCO2 63 mmHg. She underwent Video Assisted Thoracic Surgery (VATS) resection of pericardial cyst with subsequent resolution of respiratory failure.
DISCUSSION: Pericardial cysts are benign deformities of the pericardium which are usually asymptomatic and discovered incidentally. The incidence is estimated at 1:100,000 and the usual location are in the right cardiophrenic angle . When symptomatic, they may present with chest pain, dyspnea, and syncope and may be associated with pneumonia, cardiac compression, mass effect on adjacent organs and sudden cardiac death. As our case demonstrates CT scan is usually diagnostic. Asymptomatic patients are usually treated conservatively and followed every 6-12 months with imaging studies . In our case due to the respiratory failure caused by the mass effect the patient required resection.
CONCLUSIONS: Pericardial cysts are described as benign entities, but in the appropriate setting they can be life threatening. Therefore although conservative management remains the usual therapy, if cardiac or respiratory symptoms develop secondary to cyst it should be excised.
Reference #1: McMillan, A., et al., A large pericardial cyst complicated by a pericarditis in a young man with a mediastinal mass. Ann Thorac Surg, 2009. 88(2): p. e11-3
Reference #2: Larghi, A., et al., EUS-guided drainage of a pericardial cyst: closer to the heart (with video). Gastrointest Endosc, 2009. 70(6): p. 1273-4.
DISCLOSURE: The following authors have nothing to disclose: Manveen Dassan, Abhinav Saxena, Chanaka Seneviratne, Yizhak Kupfer, Igor Brichkov, Pavan Irukulla, Jignesh Patel
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