Voluminous Calcified Pericardial Cyst with Severe Right Ventricular Compression: A Multimodality Imaging Case Report

Figures

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  Multimodal imaging evaluation of a large pericardial cyst (asterisk) is depicted. In panel A Cardiac CT reveals the characteristic feature of a calcified capsule surrounding the cyst, predominantly involving the right atrioventricular groove and right ventricular free wall. In panel B Cardiac MRI (cine FIESTA) demonstrates the remarkable dimensions of the cyst and its compressive effect on the right ventricle. In panel C TTE reveals ventricular interdependence with a characteristic D-shaped interventricular septum during diastole, consistent with extrinsic right ventricular compression rather than constrictive pericarditis. Panel D, intraoperative TEE demonstrates the cyst with internal septations, supporting the parasitic aetiology. CT, computed tomography, MRI, magnetic resonance imaging; TEE, transoesophageal echocardiography; TTE, transthoracic echocardiography; RV, right ventricle; LV, left ventricle; RA, right atrium; LA, left atrium.

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  Figure 1. Chest radiography showing the calcified outline of the pericardial cyst (arrows).

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  Figure 2. Cardiac CT in short-axis view demonstrating a voluminous pericardial cyst surrounded by extensive calcified walls (arrows), causing significant right ventricular compression.

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  Figure 3. Cardiac MRI multiparametric assessment of the pericardial cyst in four-chamber view. (A) Cine FIESTA sequence showing the pericardial cyst with right ventricular compression and interventricular dependence. (B) Perfusion imaging demonstrating absence of contrast enhancement within the mass, consistent with an avascular lesion. (C) T2-weighted STIR sequence and (E) T2 mapping demonstrating absence of myocardial oedema, consistent with a chronic process. (D) LGE showing extensive pericardial enhancement. (F) ECV map showing values approaching 0% within the pericardial cyst, reflecting absence of gadolinium uptake consistent with avascular cystic content, without evidence of diffuse myocardial fibrosis. ECV, extracellular volume; FIESTA, fast imaging employing steady-state acquisition; LGE, late gadolinium enhancement; MRI, magnetic resonance imaging; STIR, short tau inversion recovery.