Ann Thorac Surg 2009;87:e30. doi:10.1016/j.athoracsur.2008.12.048
© 2009 The Society of Thoracic Surgeons
Images in Cardiothoracic Surgery
Pericardial Diverticulum in the Upper Mediastinum
Xiang Wei, MD,
Ligang Liu, MD,
Xuehai Zhu, MD,
Yi Zhang, MD,
Li Duan, MD,
Tiecheng Pan, MD*
Division of Cardiothoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
* Address correspondence to Dr Pan, Division of Cardiothoracic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan, 430030, China (Email: tcpantjh{at}yahoo.com.cn).
A 51-year-old woman was admitted to our hospital with an 8-year history of recurrent right-sided chest pain. Physical examination revealed only mild neck swelling. Magnetic resonance imaging (MRI) detected a 3- x 5- x 6-cm homogeneous cystic lesion in the right upper mediastinum extending to her neck (Figs 1A and 1B; white arrow). However, a computed tomography (CT) scan 3 months later showed a significant reduction in the size of this lesion (Fig 2,
white arrow).
With studies suggestive of an intrathoracic thyroid cyst or pericardial cyst, a cystectomy was done through median sternotomy. A fluid-filled cystic lesion was found below the lower lobe of the thyroid that extended to the proximal part of the superior vena cava and encircled the trachea. After aspiration of the fluid, the cyst was easily separated from the surrounding tissues. The neck of the cyst was attached to the pericardium (Fig 3,
white arrow), which was completely excised together with a small piece of pericardium. The pathologic findings confirmed the diagnosis of pericardial diverticulum.
The patient's postoperative recovery was uneventful. She was seen in excellent condition without any symptoms 28 months after the operation.
Only a handful of cases of pericardial diverticulum had been reported, with the location in the upper mediastinum being extremely rare. The changes in size of the lesion during a short period of time could help to differentiate pericardial diverticulum with other mediastinal cystic lesions. Although pericardial diverticulum may be observed through chest roentgenogram, CT and MRI could be more illustrative like in our case. Surgical treatment of pericardial diverticulum is indicated in symptomatic patients or when a differential diagnosis with other malignant lesions is necessary.
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Acknowledgments
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 Acknowledgments
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We thank Professor Song Wan, FRCS, from the Division of Cardiothoracic Surgery, The Chinese University of Hong Kong, for his kindness in revising the language.
