Pericardial cyst

The pericardial cyst is seen as a benign formation with thin walls. It can be recognized by the formation of a round and irregular shape, of different diameters. In the middle, these neoplasms contain a liquid medium. It changes color and consistency under the influence of various factors. It was first described in 1852. In 1926, the first successful operation to remove the cyst from the thoracic cavity was performed. 

[1], [2], [3], [4], [5], [6]

Epidemiology

Of the numerous neoplasms of the middle mediastinum, the cyst is 21-22%. In 60% the cyst is located in the cardio diaphragmatic angular plane on the right. To the left is 30% of the cysts, only 12% are located at the base of the heart muscle. Women are prone to this pathology about three times more often than the male half of the population, which is due to the peculiarities of the anatomical structure and physiology. The peak incidence falls on the age range of 20 to 55 years.

[7], [8], [9], [10], [11]

Causes of the cysts of the pericardium

The exact cause until the current time to the end is not clear. The results of numerous scientific studies allow us to conclude that the main etiologic factor is the anomalous development of the pericardial sac, occurs even in the intrauterine period. Primarily, the primary pericardial sheets are transformed. Near genetic experiments it was proved that the basis of the pericardial neoplasm develops precisely at the initial stages of fetal development. At first they are small gaps, later they are connected. There is also another theory, according to which the cyst is considered as a result of improper development of the pleura in the intrauterine period. The limited area of the pleura is separated and isolated, from which later the sprouting is formed. Gradually it develops, is filled with liquid. There is always a risk of malignant degeneration of the tumor.

The causes of tumor development in adults are traumatic injuries of the chest and heart. If there was a hematoma in a certain area, a cyst often forms in the place of its localization. Often the cause is a tumor, then the cyst is considered as one of the stages of its development. It can be provoked by inflammatory and infectious processes. Cysts are caused by pericarditis and endocarditis.

[12], [13], [14], [15]

Risk factors

In the group at high risk are people who have a family history of various abnormalities and malformations of the heart. Also, the risk significantly increases in those people who were previously prone to inflammatory, tumor and infectious diseases of the heart, with injuries and bruises.

[16], [17], [18], [19], [20], [21], [22]

Pathogenesis

At the heart of pathogenesis is the violation of embryonic development of the pericardium: the formation of lacunae, plates. Gradually, they are elongated, they are connected together. First, multiple cavities are formed, gradually they merge and form a single cavity. Liquid filling occurs.

[23], [24], [25], [26], [27], [28]

Symptoms of the cysts of the pericardium

Basically, it is asymptomatic. Often it can be found only during the study of the abdominal organs. If the disease runs with symptoms, then the patients notice painful sensations in the sternum zone, accompanied by a dry cough. The intensity of pain is directly proportional to the size of the cyst. If the tumor is localized in the zone of passage of nerves, the pain often radiates. There is compression of the mediastinum, a person observes pain, dysphagia, dyspnea. Cyanosis may appear . As a consequence, the pleuropulmonary shock state develops.

Quite often the disease is completely asymptomatic. Therefore, with any unusual sensations of discomfort, burning, pressure, you need to immediately turn to specialists, conduct a survey. Also the first symptom is: a sense of weakness, increased fatigue, weight loss, and other signs that could indirectly indicate a pathological process.

Pericardial cyst

Characterized as an education with thin walls and fluid inside. Forms a leg, less often soldered to the pericardial zone. Often occurs secretly, asymptomatically. Symptoms often appear if the cyst is fairly large. In this case, there is shortness of breath, palpitations, arrhythmia. To reveal coelomic cyst it is possible by means of roentgenological researches, a computer tomography, ultrasonic echocardiography, thoracoscopy. Treatment - only surgical.

[29], [30], [31]

Complications and consequences

The growth of neoplasm entails compression of organs. Also, the cyst rupture is no less dangerous. This complication is dangerous: the fluid inside the heart may be trapped inside the cyst. This contributes to the fact that it is at risk of malignant transformation.

[32], [33], [34]

Diagnostics of the cysts of the pericardium

It is important to undergo preventive examinations in a timely manner. The doctor will conduct a general examination, and will make the necessary studies.

It is difficult to diagnose the cyst on the basis of a visual inspection, but it is possible. So, the general picture looks approximately as follows: at the site of localization and development of the tumor process, the chest protrudes. The process of breathing is greatly weakened, and the affected part sharply lags behind the process of breathing. At auscultation, weakened breathing in the area of tumor localization. By the method of palpation, you can find a bone protrusion, a protrusion in the chest. With percussion, we can identify a weakening of percussion sound in the chest area, especially at the site of tumor localization.

[35], [36], [37], [38]

Analyzes

The main research method is instrumental. However, tests can be used to find out the general picture, identify the direction of the main processes in the body. The main analyzes are a clinical, biochemical blood test, urine and feces analysis.

The most informative is the blood test. It gives an opportunity to reveal the general tendency of the phenomena occurring in the body. So, inflammation can indicate increased ESR and an increased number of leukocytes. With a tumor process, the number of lymphocytes can drop sharply, and the ratio of the main components of the blood is also impaired.

[39], [40], [41], [42], [43]

Instrumental diagnostics

The main method by which a cyst is detected is fluoroscopy. It is necessarily performed at different angles and with different projections. On the cyst indicates darkening in the area of bronchopulmonary tissue. Gradually the blackout forms a shadow. Using this method of research, morphological and anatomical features of the cyst structure are determined. Single-chambered tumor is smooth, two-chambered - undulating. Tomographic methods allow to identify the cyst, to distinguish it from diverticula, to detect its contour. A thin-walled camera is visualized. If the patient turns, or makes movements, you can see the diverticulum of the pericardium.

Also, one of the most informative methods is considered to be the method of magnetic resonance imaging. It makes it possible to visualize the tumor, distinguish malignant from benign, as well as from the inflammatory process.

Echocardiogram in combination with ultrasound is very informative.

Catheterization is an invasive technique that is performed by a surgeon. Its essence lies in the invasion of the cardiac cavity in order to examine the atria and ventricles, to evaluate the integrity of the heart walls.

Thoracoscopy is an endoscopic method, in which it is visually possible to detect all the neoplasms that are present in the heart, to evaluate the parameters.

Differential diagnosis

The doctor must differentiate the cyst from tumors, diaphragmatic hernia and linden.

Treatment of the cysts of the pericardium

In the absence of complaints and anxiety, treatment is not required. Once signs of tumor growth are detected, surgical intervention is immediately required.

Removal of the pericardial cyst

Today, two methods are known: it can be removed by open chest surgery or thoracoscopy.

Open methodology is one of the most dangerous options. Danger of its complications, there are numerous contraindications. Danger is the high risk of developing massive bleeding during surgery. The risk of postoperative bleeding, infection, and other complications is significantly increased. The recovery period is very long.

When thoracoscopic removal, large incisions are not done. The operation involves several major incisions, then probes with a special device, which makes it possible to remove the tumor with minimal damage, is targeted. It stands out completely, so there are no repeated sprouting. The risk of bleeding, infection is virtually nonexistent. Man is recovering much faster. In general, the operation algorithm can be represented as follows: first a cut is made and the cyst is carefully examined, then the doctor begins to harvest it. This ends with a complete deletion. If the cyst is too large and filled with air, it is released from liquid media.

Treatment of the pericardial cyst by alternative means

There are no people's medicines. The only way to treat the disease is surgery, in which the tumor is removed.

Prevention

Prophylaxis of the cyst is reduced to timely diagnosis. Regular check-ups are necessary. When identifying diseases of the circulatory system, concomitant diseases, they need to be completely cured, which will reduce the risks. Avoid injury and damage.

[44], [45], [46]

Forecast

If you start to treat on time, the prognosis is favorable - the pericardial cyst can be completely removed, stop bothering the person. The recovery period, as a rule, proceeds quite easily. If treatment is not carried out, the further course of events can be extremely unfavorable, up to a lethal outcome.

[47], [48], [49], [50]