Yzhar Charuzi, M.D.,
Cedars Sinai Medical Center, Los Angeles, USA
Pericardial cyst (PC) is usually an incidental finding and commonly left as a footnote unless associated with symptom. PC is a rare congenital anomaly and symptoms mostly related to compression were described. PC were documented to rupture spontaneously, shrink by Trans thoracic aspiration or eliminated by surgery. We present here a new aspect of PC. We have been following a female with a known PC since 1998, located in the left hilar area along the left heart border proximal to the left atrial appendage. Paroxysmal atrial fibrillation (Afib) started in 2003 and was treated with anti arrhythmic drugs. Afib became persistent and in early 2016 PC was larger than its original size 77X45mm vs. 50/15mm. An ablation attempt was unsuccessful. A subsequent electrocardioversion (ECV) was unsuccessful. Imaging showed shrinkage and disappearance of the PC. Afib persisted but heart rate control was more manageable. Free of PC she is ready now for another ablation attempt. Our local review found 10 patients with a PC, consisting of 7 males and 3 females. The mean age at detection was 64.4 years standard deviation SD = 13.9, with range = 34 to 80mm; 5 were 65 or older. All 10 patients were asymptomatic and the cyst was an incidental finding on a CT scan. Seven were located on the right, 3 on the left, and 1 was central. The largest linear dimension had a mean of 33 mm SD = 10 mm, ranging from 10 to 43 mm. Follow-up CT was available on 8 patients. On follow-up, the largest dimension had a mean of 38 SD = 3 mm, with range = 30 to 40 mm.
We believe that the disappearance of a PC post ECV is a phenomenon not previously documented. The disappearance may be attributed to collateral damage from the ECV energy.