A cyst is a rounded formation with a liquid inside, the walls of which consist of the cells of the organ where it is located. It can be found in almost all tissues except bone. The outcome of the pathology is degeneration into a malignant tumor, an increase in volume, rupture, suppuration. The pericardial cyst is directly connected with the outer cardiac membrane, has thin walls and serous contents with a large amount of salts. Of all the growths in the mediastinum, this pathology is rare, in 7% of cases. It is most susceptible to women after 40.
Reasons for education
The reasons for the appearance of education are not reliably known. There are two main theories of origin:
- Violation of the structure of the serous membrane of the heart in the fetus during its formation in the womb. Weak spots form a protrusion like a diverticulum, which gradually turns into a cyst.
- Inflammation and injury. A statistician speaks in favor of this theory, according to which most often a cyst is found after pericarditis, hematoma, or as a result of tumor decay.
There is also an assumption that cystic cavities are the result of congenital changes, and pathological processes in the heart muscle or traumatic injuries of the chest only reveal them.
Symptoms and signs of a pericardial cyst
According to statistical studies, as well as the observation of my colleagues, almost half of the coelomic (pericardial) cysts are found accidentally during a routine examination and fluorography. There is no clinical symptomatology. In other cases, the patient's complaints are the same as in cardiac or pulmonary pathology.
The signs associated with compression of the bronchi, esophagus, and coronary arteries come to the fore. The patient usually talks about such deviations:
- feelings of pain or discomfort in the heart area;
- symptoms of angina pectoris with typical irradiation under the scapula and into the arm;
- rhythm disturbances, a feeling of interruption or "fading" behind the breastbone;
- the appearance of a dry cough with a change in body position and a feeling of lack of air;
- asthmatic attacks;
- difficulty swallowing;
- worsening of all signs after exercise.
When such deviations appear, the patient is usually examined by a therapist, who can refer to a cardiologist or pulmonologist for consultation.
In the photo, you can see the coelomic cyst of the pericardium in the direct and lateral images:
In a person with a pericardial cyst, the doctor notes:
- shortness of breath, heart palpitations, arrhythmias;
- decreased exercise tolerance;
- swelling of the veins in the neck;
- the appearance of a visual bulge in the chest area on the left with a superficial location of the formation;
- dullness of sound with percussion;
- increased frequency of respiratory movements, their weakening;
- pallor of the skin, acrocyanosis.
Diagnostics
Since the signs have no specific features, it is necessary to carry out a thorough differential diagnosis. To do this, use instrumental methods:
- An x-ray of the chest and mediastinal organs is mandatory. A coelomic cyst in the pericardium is found in this case as a rounded shadow in the right or left cardio-diaphragmatic corner.
- EchoCG is performed to visualize the formation. Ultrasound will make it possible to clearly determine the presence, localization, size, assess its relationship with the myocardium and differentiate with a bronchogenic or dermoid cyst, lipoma, tumor, hernia of the diaphragm. CT or MRI helps to find out the diameter, shape, location and other features of the cyst even more accurately, where you can see the image in volume and the location of the bladder relative to other organs.
- Puncture is used to determine the quality of the content. It helps to assess the biochemical and electrolyte substances in the serous fluid.
With this diagnosis, electrocardiography plays the role of an additional study. It allows you to see disturbances in rhythm and conduction due to compression of the heart muscle by the cyst.
When and how to treat
If the pericardial formation is small and does not cause clinical symptoms and discomfort, then no treatment is prescribed. A person is registered and his condition is checked from time to time. Measures are taken in case of the following problems:
- rapid growth of the cyst;
- big sizes;
- symptoms of dysfunction of the heart and mediastinal organs as a result of compression;
- high likelihood of complications (rupture, infection, internal hemorrhage).
Conservative therapy does not help in this case. The only possible cure is surgery.
Previously, the use of medical puncture was practiced, when the contents were removed, and a sclerosant was injected into the cavity. This method is almost never used, since the secretion is produced again, and the chemical can, if it gets past the cyst, cause constrictive pericarditis.
Removal is performed by thoracotomy or thoracoscopy. In an open operation, the formation is exfoliated from the lining of the heart along with the walls that form it, and the area of ​​violation of the integrity of the pericardium is sutured without harm to the functioning of the organ. The endoscopic technique belongs to the more modern and minimally invasive methods. For this, special equipment is used, which, through small incisions, allows you to relieve a person of a cyst in the pericardium. The whole process is displayed on the screen, helping the surgeon to carry out, control and correct it.
Usually, such operations are successful, complications after them are extremely rare. Recurrences following cystic excision have not been reported. The prognosis is favorable, with timely intervention, it is possible to fully restore the patient's working capacity.
Case from practice
A 39-year-old patient was admitted to my hospital. Since childhood, he had heart interruptions, which recently began to bother him almost constantly, his pulse became more frequent, and shortness of breath appeared. A month before the visit, he was treated in a polyclinic for episodic ventricular tachycardia against the background of single monomorphic extrasystoles. Took Allapinin and Amiodarone. He did not notice any particular improvement while taking the drugs.
After echocardiography, a rounded cavity formation with clear walls was found. MRI confirmed the presence of a pericardial cyst. For treatment, radiofrequency ablation was used to restore a normal pulse and to remove the cavity using thoracoscopy. A month after complete rehabilitation, Holter monitoring was performed. No rhythm disturbances were found.
In this case, a double pathology was observed. The focus of impulses in the left ventricle caused rhythm disturbances and episodes of tachycardia. The reason for the frequent pulse was a coelomic cyst, and it also acted as a provoking factor for arrhythmias and extrasystoles.
