Management of pericardial cyst in the mediastinum: a single-port approach

Pleuropericardial cysts are relatively infrequent lesions, benign in most cases, representing 7% of all mediastinal tumors.(1) The diagnosis is incidental on chest X-rays in more than 50% of the cases, since clinical symptoms are scarce.(2) Pericardial cysts are usually identified in the fourth or fifth decade of life, and they are more frequently located at the right costophrenic angle (in 70% of the cases); the left costophrenic angle (in 10-40%); and the vascular hila, superior mediastinum, or left heart border (in 5-10%).(3) The gold standard treatment for the management of those cysts is surgical resection and video-assisted thoracic surgery (VATS), the latter being the best option for these patients. We report the case of a 55-year-old male admitted to our hospital with an incidental radiological diagnosis of a mass in the anteroinferior mediastinum, measuring 45 mm and developing on the right side. The clinical history of the patient was totally negative, and he referred no clinical symptoms linked to the cyst. In order to diagnose the mass and prevent the risk of complications, the patient underwent complete surgical resection of the cyst by single-port VATS (Figure 1). Under general anesthesia and single-lung ventilation, he the patient was placed in semi-supine position, with a long gel roll placed under the right shoulder. Internal intercostal nerve blocks and continuous elastomeric pump infusion loaded with morphine were used to achieve optimal analgesia.