key: cord-0801349-ymk9ptw7
authors: Agladze, Mariam; Kim, Yungmin; Norris, Jason; Trandafirescu, Theo
title: INCIDENTAL FINDING OF A PERICARDIAL CYST IN A HOSPITALIZED PATIENT WITH COVID-19 PNEUMONIA
date: 2021-10-31
journal: Chest
DOI: 10.1016/j.chest.2021.07.1173
sha: 57a93707fa8dac0b7618d99f28382f9b3293b242
doc_id: 801349
cord_uid: ymk9ptw7

nan

Pericardial cysts (PC) are a rare entity, with an estimated incidence of about 1 in 100,000 people. While usually asymptomatic, they have the potential to cause symptoms and may require surgery if compressing adjacent structures.

Here we present a case of PC as an incidental finding on chest computed tomography (CT) in a patient with acute hypoxic hypercapnic respiratory failure due to COVID-19 pneumonia.

A 66-year-old male with a past medical history of hypertension was admitted for acute hypoxic hypercapnic respiratory failure due to COVID-19 pneumonia and was placed on non-invasive ventilation. Chest x-ray (CXR), showing patchy areas of pulmonary consolidation, was followed by CT chest significant for bilateral fibrotic changes and possible PC on the left, 6.9cm x2.9cm x8.9cm in size with no signs of compressing any structures (Fig 1,2) . The diagnosis was supported with an echocardiogram (Echo) revealing PC (6.8cmx2.7cm in size) adjacent to the left ventricle (Fig 3) . Despite aggressive treatment for respiratory failure, patient's hemodynamic status deteriorated requiring mechanical ventilation. Given his clinical status, further management of PC was deferred but will be followed clinically.

DISCUSSION: PCs constitute 4%-7% of all mediastinal masses. PC is classified into two categories: congenital (more common) and acquired, with congenital arising from failure of fusion of mesenchymal lacunae. Acquired PC might develop as a result of inflammation secondary to infections like hydatid cysts, tuberculosis, viral pericarditis or malignant metastasis, post-trauma, postcardiac surgery, etc. 50%-75% is generally asymptomatic, located on the right heart border, represents incidental findings and resolves spontaneously. Symptoms develop when PC compresses adjacent structures like the heart, esophagus or trachea, and may manifest as chest discomfort, dyspnea, cough or dysphagia, etc. PC is commonly detected on CXR and confirmed on Echo. According to Alkharabsheh, S., et al, the mean maximum diameter of PC was 5.5cm. Asymptomatic patients can be followed up with CT or Cardiovascular Magnetic Resonance every 1-2 years. For symptomatic ones, treatment options include percutaneous aspiration, video-assisted thoracoscopic surgery, laparoscopic resection or median sternotomy. PCs compressing nearby structures may lead to sudden death, cardiac tamponade, congestive heart failure, pericarditis, etc.

CONCLUSIONS: Although unknown whether our case represents congenital or acquired PC, severe inflammatory reaction secondary to COVID-19 might be suspected to be a precipitating factor in PC development. To the best of our knowledge, there are no cases reporting PC in association with COVID-19 pneumonia. While a majority of pericardial cysts are asymptomatic and might resolve spontaneously, clinicians should consider serial follow-up as big PC might lead to life-threatening complications

Clinical Features, Natural History, and Management of Pericardial Cysts

Current concepts of diagnosis and management of pericardial cysts

DISCLOSURES: No relevant relationships by Mariam Agladze, source¼Web Response No relevant relationships by Yungmin Kim, source¼Web Response No relevant relationships by Jason Norris, source¼Web Response No relevant relationships by Theo Trandafirescu

American College of Chest Physicians