Cysts Around the Heart: Differential Diagnosis and Multimodality Imaging Strategies for Paracardiac Cysts

•Paracardiac cysts (located adjacent to or inside the heart) are rarely detected.•There is a broad differential diagnosis for encountered with echocardiography.•Multimodality imaging crucial comprehensively evaluating paracardiac cysts. Paracardiac cysts, located heart, diagnosed by cardiac imaging, occurring in <0.1% of echocardiograms. Using echocardiography, computed tomography (CT), and magnetic resonance (MRI), we highlight these structures presenting 5 unique types cysts: pericardial, esophageal duplication, bronchogenic, blood, hepatic. Advanced echocardiographic strategies, including microbubble ultrasound enhancement agents (UEAs), also demonstrated. This case series emphasizes integral role multimodality strategies determining most appropriate, personalized treatment plan A 22-year-old woman no medical history presented emergency room after an episode loss consciousness. The physical exam was unremarkable, basic laboratory testing normal. electrocardiogram (ECG) showed normal sinus rhythm. Chest radiography demonstrated markedly enlarged silhouette abnormal right heart border (Figure 1A). Transthoracic echocardiography (TTE), performed due chest x-ray, revealed biventricular systolic global regional function. round, well-circumscribed echolucent lesion incidentally detected behind 2). CT iodinated contrast large fluid collection within posterior mediastinum measuring 21.5 × 11.4 14.2 cm, contiguous pericardium 1B C). Cytology from fine-needle aspiration found clear without malignant inflammatory cells. These findings were diagnostic pericardial cyst. 32-year-old man diabetes mellitus prior enlisting United States Navy. An absent left testicle noted. otherwise Subsequently, abdominal scan, examination, undescended as well incidental finding ovoid retrocardiac lesion. dedicated be mediastinal cyst 6.3 7.0 6.0 cm 3). had low radiodensity (27 Hounsfield units) inseparable esophagus, diaphragm. TTE function anatomy. However, atrium (LA), there globular, cystic structure 4A, Video After patient drank carbonated beverage, bubbles seen structure, supporting conclusion that not communication upper gastrointestinal tract 4B). intravenous (IV) injection activated perflutren lipid microsphere UEA, appeared cyst, indicating it vascular 4C, Overall suggestive either enterogenic duplication bronchogenic Given cyst’s potential future compression transformation, then underwent resection lymph node biopsy. Surgical pathology nodes benign, epithelium-lined partial denudation, wall fibrosis, chronic inflammation, consistent They now doing preparing reapply navy. 29-year-old Hashimoto’s thyroiditis new-onset palpitations. except irregular ECG atrial fibrillation. transesophageal (TEE) done preparation cardioversion fibrillation Additionally, extracardiac 5.5 diameter extrinsically compressing LA 5, Videos 4 5). hypodense, subcarinal, middle mass causing extrinsic superior LA, inferior pulmonary vein, vena cava (SVC), main artery 6A-C). scan obtained tissue characterization internal but mild peripheral rim on T2 sequences 6D). Based above included resulting arrhythmia, surgical biopsy performed. During surgery, noted productive white milky fluid. Fluid analysis macrophages, amorphous material, degenerated nonviable cellular debris, occasional detached cilia tufts. Histologic evaluation inflamed walls Atrial resolved 2 weeks later, well. 45-year-old exertional dyspnea. Aside faint murmur along their sternal border, Laboratory unremarkable. mitral regurgitation 2.0 1.4 septated, associated anterior valve (MV) leaflet. There evidence ventricular outflow obstruction other valvular 7A B, 6). Two- three-dimensional TEE further assisted characterizing 7C D, respectively; 7). Transesophageal IV UEA delayed filling lesion, its limited blood pool. year repeat interval change continue follow up cardiologist 83-year-old diverticulitis obstructive disease shortness breath referred TTE, which On subcostal views anechoic, unilocular, circumferential aspect liver. It measured 4.0 characteristic acoustic artifact far field. hepatic 8A, 8). did encroach result inflow obstruction. simple 3.7 4.5 8B). liver overall echotexture patent portal vein. Multiple kidney detected. contents 3 units, hypodense attenuation similar water 9). planned surveillance imaging. can originate any near mediastinum. clinical echocardiograms, reported rate studies, broad.1Alkhouli M. 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All here possible risk compromising normally functioning start developing symptoms demonstrates significantly interferes shape and/or structures.6Verhaert Scholar,7Najib Scholar,22Cianciulli T.F. Ventrici J.F. Marturano M.P. Saccheri M.C. Medus M.J. Redruello M.F. diagnosis.Circ 8e002729Crossref Otherwise, intervals individual basis depending location.7Najib relative rarity guidelines how perform follow-up based recurrence guidance suggest pharmacologically treated antiplatelet antibiotic prophylaxis dental procedures, unless indicated presence diseases. multitude proximal heart. aware around best recommend additional workup