Pericardial cyst as a cause of recurrent hiccups: a case report

Background: Pericardial cysts are an uncommon cause of mediastinal masses. When identified, they are often an incidental finding on imaging. However, when symptomatic, they may present with cough, dyspnea, recurrent pulmonary infections, chest pain, congestive heart failure, or dysphagia. In symptomatic cases, surgical treatment is typically warranted. We present a case where the sole symptom of presentation was recurrent hiccups, refractory to other treatments, that resolved after thoracoscopic resection. Case Description: A 51-year-old male presented to outpatient thoracic surgery clinic with a history of persistent, recurrent hiccups for 3 months. The patient’s past medical history was non-contributory. His hiccups persisted despite attempted medical therapy. On initial chest X-ray, an irregularity of the right heart border was seen. On chest computed tomography (CT), a simple fluid filled pericardial cyst was observed, in close proximity to the right phrenic nerve. The patient underwent a right video-assisted thoracoscopic removal of this pericardial cyst. Post-operatively, the patient recovered well, with complete resolution of hiccups prior to discharge on post-operative day one. No recurrence was seen during follow-up at 4 and 8 weeks. Conclusions: There are few existing cases of pericardial cysts presenting with hiccups, none of which have been approached with video-assisted thoracoscopic surgery (VATS), to our knowledge. In this case, we observed persistent hiccups as the sole symptom of presentation of a pericardial cyst. Upon surgical removal via a VATS approach, there was complete symptom dissipation. Pericardial cysts should be considered in the differential diagnosis of recurrent hiccups. If identified, surgical resection can result in complete cessation of symptoms.