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Ann Thorac Surg 1998;66:607
© 1998 The Society of Thoracic Surgeons

Correspondence

Percutaneous drainage of pericardial cyst with right-sided heart failure

Basem Shabb, MDa, Maurice Khuri, MDa, Maurice Haddad, MDa

a Departments of Cardiothoracic Surgery, Cardiology, and Diagnostic Radiology, American University of Beirut-Medical Center, Beirut, Lebanon

To the Editor

We read with interest two case reports of complicated pericardial cysts presenting with acute right heart failure. Both were treated surgically with resolution of the symptoms. One patient was treated thoracoscopically [1] and the other via a median sternotomy [2]. In both cases, however, the posterior aspect of the cyst was not removed because of adherence to the right ventricular free wall.

We recently treated an 18-year-old woman who presented with vague abdominal discomfort and progressive dyspnea of 10 days’ duration. Physical examination revealed signs of right heart failure. Transesophageal echocardiography demonstrated a large cyst with fibrin strands compressing the inflow portion of the right ventricle and right atrium with tamponade of the right ventricle. A contrast-enhanced computed tomographic scan revealed a 9x9x4-cm cystic lesion containing thick fluid compressing the right ventricle and separate from it. Indirect hemagglutination for hydatid disease was negative. Because of the benign nature of the cyst radiologically and the clinical suspicion of a pericardial cyst, percutaneous drainage under computed tomographic guidance was undertaken through the left fourth intercostal space. One hundred twenty milliliters of sanguineous fluid was recovered and an 8F catheter was left in place. The cavity was sclerosed with 30 mL of pure alcohol. The catheter was removed after 3 days of minimal drainage. Follow-up transthoracic echocardiography showed complete resolution of the right ventricular tamponade and total collapse of the cyst. Cytologic examination showed few lymphocytes. After 4 months the patient has had no evidence of recurrence as shown by echocardiography.

Hydatid disease should be considered when evaluating mediastinal cystic lesions, especially in endemic areas. Contrast-enhanced computed tomography offers an advantage over transesophageal echocardiography in clearly demonstrating adipose tissue between the cyst and the right ventricular free wall. Whenever there is a strong suspicion of a complicated pericardial cyst, consideration may be given to percutaneous aspiration and sclerosis.

References

  1. Borges A.C., Gellert K., Dietel M., Banman G., Witt C. Acute right-sided heart failure due to hemorrhage into a pericardial cyst. Ann Thorac Surg 1997;63:845-847.[Abstract/Free Full Text]
  2. Ng A.F., Olak J. Pericardial cyst causing right ventricular outflow tract obstruction. Ann Thorac Surg 1997;63:1147-1148.[Abstract/Free Full Text]



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