Contemporary Review of Clinical Features, Multi-Modality Imaging, and Management of Pericardial Cysts

TL;DR

Pericardial cysts are rare, benign heart-related growths that are often found by accident and can mimic other heart conditions, requiring careful diagnosis and management.

Contribution

This paper offers a comprehensive review of the clinical features, imaging, and treatment of pericardial cysts.

Findings

Pericardial cysts are usually asymptomatic and discovered incidentally through imaging.

Advanced imaging like CT or MRI is best for accurate diagnosis and differentiation from other mediastinal masses.

Surgical resection is the most effective treatment for symptomatic or enlarging cysts.

Abstract

Pericardial cysts (PCs) are rare, benign congenital abnormalities that are encountered as mediastinal lesions. Despite their rarity, they remain clinically important due to their potential to mimic other mediastinal or cardiac pathologies and their capacity, in select cases, to cause significant complications. PCs are typically identified incidentally on imaging studies such as chest x-ray or transthoracic echocardiography, as most patients remain asymptomatic throughout their lives. When symptoms do occur, they are often nonspecific and related to compression of adjacent structures. Serious complications—including infection, rupture, and, rarely, cardiac tamponade—have been reported, underscoring the importance of accurate diagnosis and appropriate follow-up. Definitive characterization of PCs is best achieved using advanced imaging modalities such as cardiac computed tomography or cardiac magnetic resonance imaging, which help differentiate PCs from other mediastinal masses. While many PCs remain stable or even regress spontaneously, intervention may be warranted for symptomatic patients, enlarging cysts, or when the diagnosis remains uncertain. Therapeutic options include percutaneous aspiration, which carries a risk of recurrence, and surgical resection, which offers definitive treatment with excellent outcomes. This review provides a comprehensive overview of the etiology, clinical manifestations, diagnostic evaluation, differential diagnosis, complications, and management strategies for PCs.

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