Bava G L, Magliani L, Bertoli D, Gorrieri P F, Rimini A, Zaccagnini G, Bertolini A
Department of Cardiovascular Surgery and Cardiology, Gaslini Pediatric Institute, Genoa, Italy.
Clin Cardiol. 1998 Nov;21(11):862-4. doi: 10.1002/clc.4960211118.
Pericardial cysts are usually detected by chance are are clinically silent in most cases. Nevertheless, symptoms and serious complications may occur. We describe a case of pericardial cyst diagnosed in an 8-year-old boy who was admitted with chest pain. Echocardiography revealed a mild to moderate pericardial effusion and a 7.5 x 5.5 cm intrapericardial echo-free lesion consistent with a pericardial cyst. Surgery was carried out 3 days afterward because of the patient's worsening condition, the progressive increase of pericardial effusion, and the onset of initial signs of cardiac tamponade. The cyst showed a long and easily movable vascular pedicle and inflammatory areas involving the pericardial surface. Like the pericardial effusion, the contents of the mass appeared as serosanguineous fluid on aspiration. Histologic examination confirmed the diagnosis of pericardial cyst and showed findings according to ischemia-related lesions of the cyst. The coexistence of pericardial cyst and cardiac tamponade is very unusual. The atypical anatomy and clinical course suggest a distinct and so far undescribed pathogenetic mechanism for this association: the torsion of a vascular pedicle and the subsequent development of ischemia-related lesions of the cyst.
心包囊肿通常是偶然发现的，大多数情况下临床上无症状。然而，也可能出现症状和严重并发症。我们描述了一例在一名因胸痛入院的8岁男孩中诊断出的心包囊肿病例。超声心动图显示轻度至中度心包积液以及一个7.5×5.5厘米的心包内无回声病变，符合心包囊肿。由于患者病情恶化、心包积液逐渐增加以及心脏压塞初始体征的出现，3天后进行了手术。囊肿显示有一个长且易于移动的血管蒂以及累及心包表面的炎症区域。与心包积液一样，抽吸时肿块内容物呈血性浆液性液体。组织学检查证实了心包囊肿的诊断，并显示出与囊肿缺血相关病变相符的结果。心包囊肿与心脏压塞同时存在非常罕见。非典型的解剖结构和临床过程提示这种关联存在一种独特且迄今未描述的发病机制：血管蒂扭转以及随后囊肿缺血相关病变的发展。
