Brochogenic cyst ruptured in the pericardial cavity with pericardial tamponate formation

Clinical History

48 year old female presented to our department due billateral leg oedema. The patient underwent a plane X-ray film, cardiac US, chest computed tomography (CT), and abdominal US examination.

Imaging Findings

A 48 year old female presented to our department due to upper respiratory tract infection and subsequent bilateral leg oedema. A plane X-ray film (Fig. 1) demonstrated a double contour at the upper mediastinum with concomitant increase of carina angle and mediastinal density. A cardiac US examination (Fig. 2) was performed, which visualized an external cystic lesion compressing the left atrium from behind. The chest CT examination (Fig. 3), visualized, a well-defined water attenuation mass at the right superior mediastinum. Milk of calcium, calcium level was also observed indicative of bronchogenic cyst. The patient was referred to cardiosurgery department but due to her religion beliefs, she denied to be operated. Three days later she returned to our hospital with jaundice and abdominal pain. The abdominal ultrasound examination (Fig. 4) revealed congested hepatic veins and oedematous gall bladder wall, findings indicative for cardiac insufficiency. The patient again denied hospitalization. One day later she returned to the cardiology department. She underwent again a cardiac US examination where the cystic external lesion has disappeared and a pericardial effusion restricting the cardiac function was developed. Finally the patient was operated and the patient discharged several days later in a good clinical condition. The pericardial fluid was analyzed histopathologically and was compatible with chronic inflammatory reaction. A reactive lymph node was also removed and analyzed. Pathologic examination was consistent with the final diagnosis of bronchogenic cyst ruptured in the pericardial cavity

Discussion

Bronchogenic cysts arise from abnormal branching of the bronchopulmonary foregut and are closely situated to the tracheo-broncheal tree. They are lined by respiratory epithelium, smooth muscle, mucus glands and cartilage are frequently found in the cyst wall. The most frequent locations are right para-tracheal and carinal. CT findings include a smooth oval, or tubular non-enhancing mass with sharp margins with typical location. 50% the lesions have water attenuation densities but in the rest of the cases the density is variable. In some case is indistinguishable from mediastinal tumour. Complicated cyst may have thick wall.
In complicated or atypical cases operation or percutaneous drainage may be needed.

Differential Diagnosis List

Final Diagnosis

Bronchogenic cyst ruptured in the pericardial cavity with pericardial tamponate formation

URL:	https://www.eurorad.org/case/8483
DOI:	10.1594/EURORAD/CASE.8483
ISSN:	1563-4086