A giant pericardial cyst as rare cause of reflux and chest discomfort: a case report

Background: Pericardial cysts are a rare form of congenital mediastinal cystic lesion. They are usually asymptomatic and are often discovered incidentally, although some patients may present with a variety of different symptoms. The presence of small, asymptomatic pericardial cysts does not need treatment; however, large and/or symptomatic cysts may require surgical intervention. Case summary: We report a case of a 42-year-old man with a 7-year history of dysphagia and non-specific thoracic complaints. Multiple gastroenterological examinations and proton pump inhibitor therapies did not find the cause or led to improvement of the symptoms. Finally, a giant pericardial cyst with compression of the oesophagus as well as a lung atelectasis was identified as the cause of the patient's symptoms. The patient underwent successful robotic-assisted pericardial cyst resection with subsequent complete resolution of symptoms.Correctly diagnosing a pericardial cyst can be challenging due to its rarity and the wide range of symptoms and may take years of investigations before a diagnosis can be made. Discussion: This case demonstrates that-despite their rarity-pericardial cysts should be considered in the differential diagnosis, even in cases of very uncommon symptoms such as dysphagia.