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Chest Imaging

Pericardial cyst

the result of an outpouching of the parietal pericardium that is lined by mesothelial cells. Most of the pericardial cysts are unilocular. They usually contain clear yellow fluid and do not communicate with the pericardial space. Generally, pericardial cysts are detected incidentally in asymptomatic patients. The majority of them are located in the right anterior cardiophrenic angle although they may occur anywhere in the pericardium, posterior cardiophrenic angle or superior retroaortic pericardial recess. On chest radiographs, they appear as well defined round or oval masses in contact with the heart (Fig.1). Calcification is exceptional. On CT, they appear as smooth well-defined masses without any perceptible wall. They typically demonstrate fluid attenuation that may be close to water or, because of viscous fluid, may be in the soft tissue range (Fig. 1b). Similarly the MR signal characteristics are typically that of water (low signal intensity on T1-weighted images, and bright signal on T2- weighted images) (Fig. 1c, d). but may vary depending on the cyst content. The pericardial cyst may be of almost any size. Rapid change in size, particularly a decrease in size, suggests a pericardial diverticulum rather than a pericardial cyst. Also, see cyst pericardial.

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Fig.1

a. PA chest radiograph showing a well-defined oval mass contigous to the heart. b. Postcontrast CT scan shows a well circumscribed oval mass abutting the heart. The density of the mass is higher than that of water and it is difficult to distinguish between a soft tissue mass and a cyst. On T1- (c) and T2- (d) weighted MR scans, the lesion appears typical of cyst. The location and continuity between the mass and the pericardium permit the diagnosis of a pericardial cyst.
Pericardial cyst, Fig.1 (a)
Pericardial cyst, Fig.1 (b)
Pericardial cyst, Fig.1 (c)
Pericardial cyst, Fig.1 (d)