An Incidental Finding of a Giant Pericardial Cyst Successful Resected by Video-Assisted Thoracoscopic Surgery (VATS): A Case Report

Pericardial cysts are rare benign mass of the mediastinum. They are frequently asymptomatic and diagnosed incidentally, although some patients may present with persistent cough, chest pain and dyspnoea. A conservative approach with radiological or echocardiographic follow-up may be indicated for small and asymptomatic pericardial cysts, while for symptomatic, giant or rapidly enlarging pericardial cysts, surgery is recommended, with sternotomy, thoracotomy or video-assisted thoracic surgery (VATS); surgical treatment include cyst resection, cyst aspiration, and sclerosis after aspiration. We report a case of a 64-year-old lady, who presented with clinical features suggestive of intestinal occlusion due to volvulus, with an incidental finding of a giant pericardial cyst in the right cardiophrenic angle, measuring approximately 10.9 cm x 9.7 cm x 9.8 cm. The patient underwent VATS and the cyst was completely excised, after the initial intra-operative needle aspiration to reduce the size and facilitate its removal. No complications were observed; the patient was discharged on the sixth postoperative day. An abdominal CT scan extended to the chest, performed 27 months after surgery for recurrent intestinal obstruction, revealed no recurrence of the cyst. Pericardial cysts are usually benign, but they can cause compression on adjacent structures such as the heart or lungs and may be complicated by inflammation, infection, or rupture. Therefore, if symptomatic, rapidly growing, or giant, pericardial cysts require surgical intervention. Initial intraoperative needle aspiration facilitates VATS resection of giant pericardial cysts.