A rare case of epicardial cyst

Epicardial mesothelial cyst originating from the roof of the left atrium: a case report

Background

Epicardial mesothelial cysts are cysts that are attached to the epicardium within the pericardial cavity. Reports on epicardial mesothelial cysts are rare, and limited studies have investigated their surgical management. Here, we report the rare case of an epicardial cyst originating from the roof of the left atrium.

Case summary

A 73-year-old man with dyspnoea on exertion and lower limb oedema was diagnosed with a giant cyst (diameter, 7 cm × 4.5 cm) in the pericardial cavity using computed tomography. Off-pump surgery was performed with successful resection of the cyst with a pedicle connected to the roof of the left atrium. Histological examination confirmed the mesothelial origin of the tumour cells.

Conclusion

Cysts rarely develop within the pericardial cavity, especially an epicardial cyst. The few studies exploring this disease have suggested that patients with this condition may be asymptomatic or have mild breathlessness or cardiac tamponade, which might be occasionally or incidentally diagnosed. Sufficient preoperative evaluation, particularly involving the coronary artery, is essential, and a rational way of surgery should be planned considering all factors.

Off-pump resection of a giant inflamed epicardial cyst

Background

Epicardial cysts are rarer benign tumors than pericardial cysts. There have been few reports on surgical management for epicardial cysts.

Case presentation

A 73-year-old woman with dyspnea on exertion had a giant cyst (12 × 10 cm in diameter) on preoperative computed tomography. Compression of the left atrium and ventricle by the cyst was considered to be the cause of her symptoms. The cyst was diagnosed with an epicardial cyst intraoperatively. Although the cyst adhered to surrounding tissues, it was successfully resected with off-pump surgery by using a heart positioner and an ultrasonic scalpel.

Conclusions

Surgeons should consider off-pump surgery as an alternative to video-assisted thoracoscopic surgery and on-pump surgery for complicated epicardial cysts.

Epicardial cysts: report of two rare cases

Epicardial cysts originating directly from the epicardium are seen very rarely. Complete surgical excision is recommended when these cysts are detected. If cysts compress surrounding vital structures, cardiopulmonary bypass (CPB) should also be considered. We report herein 2 cases of multiloculated epicardial cysts, both of which were successfully excised, 1 with CPB.