An Atypical Presentation of a Recurrent Pericardial Cyst

Figures

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  Figure 1. CT Angiography Imaging (A) Axial and (B) coronal views of the chest via computed tomography angiogram from August 2018 showing a low-density mass approximately 3.6 cm × 2.1 cm in size in the aortopulmonary window region (yellow arrows). Axial (C) and coronal (D) views of the chest via computed tomography angiogram from January 2024 revealing the same indeterminate low-density mass within the anterior mediastinum now increased in size, measuring approximately 6.3 cm × 5.4 cm (yellow arrows).

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  Figure 2. MR Imaging (A) Axial T2, (B) axial T1 precontrast, (C) coronal T2, and (D) axial postcontrast T1 views of the chest via magnetic resonance imaging in February 2024 revealing a thin-walled simple cystic mass abutting the superior margin of the left ventricle, main pulmonary artery segment, and left pulmonary artery measuring 5.8 cm × 4.8 cm × 7.6 cm (yellow arrows). There is no associated solid mass component or abnormal enhancement, mediastinal lymphadenopathy, or pericardial effusion. These findings are most consistent with a pericardial cyst.

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  Figure 3. Intraoperative Imaging (A) Presurgical and (B) postsurgical images of the pericardial cyst resection performed in February 2024. There was likely residual cyst wall along the posterior pedicle of the phrenic nerve, aorta, superior left pulmonary vein, and the main pulmonary artery extending onto the left main pulmonary artery seen in image B (yellow arrows).

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  Figure 4. Postsurgical CT Imaging (A) Axial and (B) coronal views of the chest via computed tomography imaging without contrast from September 2024 showing interval recurrence of the pericardial cyst in a similar location in the anterior mediastinum abutting the superior margin of the left ventricle, main pulmonary artery, and anterior margin of the left pulmonary artery (yellow arrows). The cystic structure measured approximately 5.6 cm × 4.1 cm × 5.7 cm.