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J Thorac Cardiovasc Surg 1994;107:313-314
© 1994 Mosby, Inc.

LETTERS TO THE EDITOR

Thoracoscopic resection of a pericardial cyst: A case report

W. Weder, H. P. Klotz, L. von Segesser, F. Largiadèr

Department of Surgery
University Hospital
Zurich, Switzerland

To the Editor:

Mediastinal or paramediastinal tumors are most often asymptomatic and detected incidentally on a chest radiograph. The differential diagnosis includes a long list with various possibilities. Repeated radiologic studies are generally performed to confirm a suspected diagnosis. However, only the histopathologic examination of the tumor is conclusive. Thoracoscopy enables, with a fast and minimally invasive method, definitive diagnosis and treatment of many of these tumors.

Recently, a 49-year-old patient was admitted to the Department of Surgery at University Hospital Zurich because of an asymptomatic tumor in the anterior mediastinum, detected on a chest radiograph. The history and physical examination revealed normal parameters. Computed tomographic scan (Fig. 1) showed a well-defined cyst in the right cardiophrenic angle, without contact with the heart. A thoracoscopy was performed with a double-lumen tube and a left lung ventilation, with the patient under general anesthesia. A 1 cm trocar was inserted in the eighth intercostal space in midaxillary line and a video camera was inserted (Wolf CCD-Endocam 5370; Richard Wolf GmbH, Knittlingen, Germany). Two 0.5 cm trocars were in serted through the eighth intercostal space in the anterior and posterior axillary line. The inspection of the chest showed a thin-walled pericardial cyst measuring 4 x 3 cm connected to the pericardium by a pedicle (3 mm diameter). The duct was divided with scissors (Fig. 2) and the cyst was emptied of clear, yellowish fluid and extracted through the trocar. A chest tube was inserted through a trocar and left for 24 hours. Operation time was 15 minutes. The patient returned to work after 3 days.



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  		Fig. 1. Computed tomographic scan demonstrates a well-defined cyst (asterisk) in the right cardiophrenic angle.

 


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  		Fig. 2. The cyst was connected to the pericardium by a pedicle. This was severed and the cyst was removed thoracoscopically.

 
Pericardial cysts are in general an asymptomatic malformationGo 1 of the pericardium and found incidentally on a routine roentgenogram. Their typical location is the right cardiophrenic angle, but they can be located at other sites. Their radiologic appearance is normally cystic but can be exceptionally solid.Go 2 Removal is indicated to confirm the diagnosis. Thoracoscopy allows, with a minimally invasive method, diagnosis and treatment of such cysts; in the case of another mediastinal or intrathoracic tumor (such as a dermoid, a neurogenic tumor, cyst of the foregut, or others) resection is often possible as part of the procedure. We consider thoracoscopy to be the method of choice if a radiologically indicated pericardial cyst is to be confirmed by resection.

References

  1. Lambert AV. Etiology of thin-walled thoracic cysts. J THORAC SURG 1940;10:1-7.
  2. Stoller JK, Shaw C, Matthay RA, Enlarging, atypically located pericardial cyst: recent experience and literature review. Chest 1986;89:402-6.[Abstract/Free Full Text]



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