Ann Thorac Surg 2008;86:315. doi:10.1016/j.athoracsur.2007.09.012
© 2008 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Unusual Case of Chest Pain
Giuseppe De Luca, MD*,
Salvatore Griffo, MD, PhD,
Sonia Galzerano, MD
Thoracic Surgery Unit, University Federico II, Naples, Italy
* Address correspondence to Dr De Luca, C/So Secondigliano 519, Napoli, 80144, Italy (Email: giu.deluc{at}libero.it).
A 55-year-old woman was referred to our hospital with dry cough, parossistic tachycardia, and chest pain for 4 months. The pain was dull, intermittent, and localized on the right side thoracic region. It did not change with breathing, but increased intensity with physical exercise and reduced when the patient took ketorolac 30 mg by intramuscular injection. Physical examination, electrocardiogram, and laboratory findings were within normal limits. The chest radiograph showed a well-defined density in the region of the right cardiophrenic angle, near the right border of the heart (Fig 1A,
arrows). Chest computed tomography scan demonstrated a cystic and rounded mass, 8 x 6 cm in diameter, connected to the right heart border. The patient underwent video-assisted thoracoscopic surgery under general one-lung ventilation anesthesia. The cyst appeared hemispherical, smooth with a peduncle (Fig 1B). It was excised en bloc by using a linear endoscopic stapling device (Endo-GIA 30-3.5 mm; United States Surgical, Tyco Healthcare Group LP, Norwalk, CT; Fig 1C). The postoperative course was uneventful, with complete clinical improvement, and the patient was discharged to home after 4 days. Histologic examination was compatible with the diagnosis of a pericardial cyst with evidence of inflammation. Microscopic view (hematoxylin-eosin stain, original magnification x40) showed fibrous connective tissue (Fig 1D, white arrow), a single layer of mesothelial cells (Fig 1D, black arrow), and polymorphonuclear leukocytes (Fig 1D, gray arrow). The chest pain disappeared after video-assisted thoracoscopic surgery; 1 year later, the patient is in good health and chest radiography revealed no sign of recurrence. Pericardial cysts rarely cause symptoms and usually are found incidentally during routine chest radiograph or discovered postmortem. The symptoms can be due to compression of adjacent organs and, in rare cases, to torsion or inflammation of the cyst [1]. The definitive treatment of pericardial cyst, for symptomatic patients, is surgical, and the thoracoscopic approach is the best method for its excision [2].
 |
References
|
|---|
- Borges AC, Gellert K, Dietel M, Baumann 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]
- Horita K, Sakao Y, Itoh T. Excision of a recurrent pericardial cyst using video-assisted thoracic surgery Chest 1998;114:1203-1204.[Medline]
Top
References
