The differential diagnosis of paracardiac lesions: Pericardial cysts

The differential diagnosis of paracardiac lesions includes pericardial cysts (PC), which are benign, developmental lesions. Patients with PC are usually asymptomatic, although chest pain or dyspnea may occur. The diagnosis may be established by chest roentgenogram (radiographic contour and location), fluoroscopy (changes in shape with respiration or positioning the patient), and echography (smooth, cystic contour and characteristic location). We present the diagnostic approach to patients with PC, and a review of the case histories of 12 patients with PC. Two symptomatic patients with PC were treated with surgical excision. Cyst aspiration in two patients yielded clear fluid and was initially considered therapeutic, but was followed by gradual reaccumulation of fluid. Six of ten asymptomatic patients followed for three to ten years did not develop symptoms, nor was there radiographic evidence of progressive PC enlargement. Three of ten died from unrelated causes during the follow-up period. Although symptomatic patients with PC may require surgical excision, asymptomatic patients with PC should be managed conservatively.     

Value of two-dimensional echocardiography in the diagnosis of pericardial cysts

Four adult patients with pericardial cysts were studied by two-dimensionalechocardiography. In all cases echocardiography demonstrateda round echo-free structure, of varying size, related to oneof the cardiac chambers, from which it was separated by a definitewall of echoes. M-mode echocardiography in the three cases inwhich it was performed, failed to yield the diagnosis. This report assesses the importance of two-dimensional echocardiographyand its greater reliability and sensitivity compared with: (1) M-mode echo in identifying pericardial tumors and establishingtheir relationships to nearby cardiac structures, and (2) standard chest X-ray in differentiating solid masses fromcysts and in defining the characteristics of cysts walls. Particular stress is laid on the role of two-dimensional echocardiography leading directly to surgery in patient number 4,who had a teratoma and in whom early surgery was essential. The high sensitivity and the ability of the technique to differentiatesolid from cystic masses and to define their relationships withcardiac chambers make it a reliable method for assessing pericardialcysts.     

Computer tomography diagnosis of cardiac and pericardial space-occupying lesions

Cardial and paracardial space occupations need a rapid, possibly non-invasive diagnosis. The echocardiography and the computer tomography are practically available. At the instance of 17 intracardial space occupations (4 solid tumours and 13 thrombi), which were found in a total number of 600 cardio-computer-tomographies, and several selected peri- und paracardial space occupations the high diagnostic significance of the computer tomography is demonstrated. With the computer tomography a standardized method independent of the investigator is available which in qualitative respect appears of the same value as to echocardiography in the diagnostics of the intracardial space occupations and in the peri- and paracardial space occupations the non-invasive method is the method of choice.     

A case of multiple pericardial hydatid cysts.

Pericardial cysts are rare developmental benign intrathoracic lesions and constitute 7% of all mediastinal tumors. As many as 70% of the cysts are found in the right cardiophrenic angle. Unusual locations include the left costophrenic angle, the hilum and the superior mediastinum at the level of the aortic arch. Cysts arising inside the pericardial cavity and attached to the heart are exceedingly rare. We describe a case of multiple pericardial hydatid cysts.     

Esophageal duplication cyst: a challenging diagnosis of a paracardiac mass

We present a case of esophageal duplication cyst, echocardiographically appearing as a mass above the roof of the left atrium and behind the right pulmonary artery. The differential diagnosis and the management of such disease are discussed.     

Echocardiographic diagnosis of pericardial disease.

Echocardiograms were performed in 11 patients with constrictive pericarditis or effusive-constrictive pericarditis confirmed by cardiac catheterization and pericardiectomy. Three echocardiographic patterns of pericardial disease were noted and were related to three types of pericardial pathology. Parallel moving echoes separated by a clear space were reflected from chronically fibrosed and thickened pericardium without associated pericardial exudate. Effusive-constrictive pericarditis or subacute wet pericarditis was characterized on the echocardiogram by a posterior echo-free space representing the liquid pericardial effusion and multiple ultrasonic lines from the thickened visceral pericardium. Subacute dry pericarditis was associated with numerous ultrasonic signals filling the space between the visceral pericardium and the relatively flat parietal pericardium. These ultrasonic signals were reflected from coagulated pericardial exudate which was adherent both to the parietal pericardium and the visceral pericardium. Parallel moving echoes or dense bands of echoes were reflected from either or both thickened visceral and parietal pericardium.     

Parathyroid cysts. Their differential diagnosis from thyroid pathology. A report of 2 cases

Parathyroid cysts are rare in clinical practice, but, when they appear, they can be mistaken for more common thyroid conditions, that can incidentally be associated with them. We present two cases of parathyroid cysts. One of them was misdiagnosed of thyroid nodule and the other was found in the context of a normo-functioning multinodular goitre. In this last case, the presenting symptoms had raised the suspicion of malignancy. Both of them responded favorably to evacuation of the liquid by means of a puncture-aspiration with a fine needle (PAFN). Our clinical cases show that the diagnosis of parathyroid cyst should be considered in patients with a cervical mass, even if an evident thyroid condition is present. They may be accurately diagnosed by means of PAFN and determining PTH in the cystic liquid, whose characteristics help to predict its side of origin.     

The tale of spring water cysts: a historical outline of surgery for congenital pericardial diverticula and cysts

Congenital pericardial diverticula and cysts are extremely uncommon lesions within the anterior mediastinum. Both lesions derive from the pericardial celom and represent different stages of a common embryogenesis. Initial reports date from the 19th century. Surgical pioneers were Otto Pickhardt, who removed a pericardial cyst at Lenox Hill Hospital in New York in 1931, and Richard Sweet, who accomplished the first resection of a pericardial diverticulum at Massachusetts General Hospital in Boston in 1943. These lesions were also called spring water cysts because they usually contain watery, crystal-clear fluid. This history outlines the milestones of evolving surgical management, from the first report in 1837 up to the present time.     

The imaging diagnosis of pericardial agenesis

Pericardial agenesis is a rare anomaly, difficult to diagnose. Its evolution is usually benign. However, on rare occasions, partial defects have been the cause of sudden death. Therefore, surgical treatment has sometimes been indicated, even though in the cases were asymptomatic. We report the case of a 50 year-old woman with partial pericardial agenesis and herniation of left atrial appendage trough. The defect was discovered by a routine chest x-ray and treated in a conservative way. Current diagnostic and therapeutic techniques are reviewed.     

低钠血症诊断思路

低钠血症(血清钠<135 mmol/L)是临床最常见的电解质紊乱之一,临床表现主要包括神经系统和肌肉系统表现两个方面。首先应该查血渗透压水平除外假性低钠血症,尿渗透压检查可以鉴别大量饮用低渗液体或其他肾外失钠的情况,容量判断有助于进一步鉴别低钠血症原因。利尿剂过量、脑耗盐综合征和盐皮质激素减少都能造成低容性低钠血症。而等容或高容性低钠血症则常常因为抗利尿激素不适当分泌综合征、甲状腺激素不足、糖皮质激素缺乏或心、肝、肾功能不全引起。     

Invasive pericardial hydatid cyst: Excision of multiple huge cysts

Cardiac hydatid cyst is rare even in endemic countries, and poses a therapeutic challenge due to varying presentation and unpredictable pre-, peri-, and postoperative complications. We herein present a case of multiple, multifocal, huge pericardial hydatid cyst, with invasion into the left ventricle and main pulmonary artery in a young male patient, presented with atypical chest pain.     

2-dimensional echocardiography in the evaluation of pericardial pathology: new prospects for its differential diagnosis

We examined retrospectively the M-mode and two-dimensional echocardiograms performed in our laboratory on 227 patients with pericardial diseases, in order to assess the capabilities and limits of echocardiography in this field. We observed 4 patients with congenital absence of the pericardium, 10 with of constrictive or infiltrative-adhesive pericarditis, 213 pericardial effusions, associated with left pleural effusion in 36 cases and with different kinds of intrapericardial masses in 33 cases. Through qualitative analysis of the echogenicity of such masses some aspects were singled out which may prove useful in identifying intrapericardial fat, as well as tumors. We also suggest new ways of using specific echocardiographic sections to differentiate left pleural effusions from pericardial effusions, and to identify very small pericardial effusions.