1234 Enlarging Pericardial Cyst Compressing the Right Ventricle

Abstract 52-year-old Indian builder initially presented to his General Practitioner with exertional breathlessness but no angina. His medical history included previous tuberculosis infection, Type 2 Diabetes Mellitus and hypothyroidism. He was referred the cardiologist exclude coronary artery disease. Stress testing found T-wave inversion in inferior electrocardiogram leads transthoracic echocardiogram showed reduced right ventricular (RV) function basal wall hypokinesia. Cardiac Magnetic Resonance Imaging (MRI) revealed a 5cm x 2.5cm pericardial cyst (Figure 1a). As imaging suggested minimal RV compression venous obstruction, patient investigated for other causes of breathlessness. Repeat computed tomography (CT) two years later demonstrated enlargement (6cm 3.6cm) contrast reflux into vena cava (IVC) 1b). Due worsening breathlessness, surgical excision offered. Surgery attempted through lower hemi-sternotomy. However, due limited access thickened pericardium, median sternotomy performed. The measured 10cm 7cm heavily adherent wall, atrium IVC preventing complete excision. therefore unroofed, releasing cheese-like material suspicious tuberculous 2). Adhesiolysis undertaken remove remaining wall. Prior closure, inflamed tissue excised. Histopathology chronically pseudocyst necrotising non-necrotising granulomatous inflammation. Ziehl-Neelsen, Grocott, Gram periodic acid-Schiff-diastase stains were negative. Intraoperative histological findings diagnosis cyst. recovered uneventfully significant symptomatic improvement at 2-month follow-up.