pericardial cyst
Introduction
Introduction to pericardial cyst Pericardial cyst is a cyst that occurs near the pericardium. The most common site is the right palpebral horn, but it also has a higher position and even extends to the upper mediastinum. It is generally believed that the cause of the formation is in the embryonic stroma during embryonic pericardium. A gap has occurred. This gap merges into the original pericardial cavity. If a gap can not be fused with other gaps, and does not communicate with the pericardial cavity, it develops into a pericardial cyst. For example, the gap and the pericardial cavity are called pericardial diverticulum. Pericardial cysts have single or multiple rooms and consist of saclike thin-walled mesothelial cells. The capsule contains a slurry or a hydrophobic liquid. Often attached to the outer wall of the pericardium, is a benign lesion, rarely causes compression symptoms. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific population Mode of infection: non-infectious Complications: pneumonia, adhesive intestinal obstruction
Cause
Pericardial cyst
Pericardial cyst is a primitive cavity in the embryonic period and can not be separated into other pericardium into a pericardium, but a cavity is formed separately, and then it can develop into a pericardial cyst. The cyst wall is thin and transparent, the outer wall is loose connective tissue, and the inner wall is a single layer. The mesothelial cells have a blood vessel distribution, similar to pericardial tissue, containing a clear or pale yellow liquid, occasionally a bloody liquid.
Prevention
Pericardial cyst prevention
Because the disease will have some compression symptoms when the cyst is large, the patients who are diagnosed should be actively operated to prevent serious complications if circumstances permit.
Complication
Pericardial cyst complications Complications pneumonia adhesion intestinal obstruction
Surgical treatment is a more effective measure of this disease, the effect is more satisfactory, but there are some complications, mainly postoperative complications, such as wound infection, postoperative intestinal adhesions and pneumonia, etc. Posterior intestinal adhesion is a common complication after abdominal surgery. However, when some cysts are low in the pericardial cyst, the operation will involve the abdominal cavity, so intestinal adhesion will occur. Clinical abdominal pain and abdominal distension are the main symptoms. Very high, severe cases can occur with adhesive intestinal obstruction.
Symptom
Symptoms of Pericardial Cysts Common Symptoms
Pericardial cysts are relatively rare, accounting for 8.9% of mediastinal tumors and cysts, and 17% of mediastinal cysts. The reason for the lower incidence is that except for the rare disease, most of them are asymptomatic, and some cysts are small and mediastinum Overlap, not easy to be found, the age of onset is mostly young and middle-aged, most patients have no symptoms, and other reasons are chest fluoroscopy. The symptoms are palpitations, shortness of breath, cough and pre-cardiac discomfort, and some patients can see abnormal ECG. It may have a certain relationship with the compression of the tumor. In a few cases, the cyst is pressed by the sacral nerve to cause pain in the flank of the affected side, and it is radiated to the shoulder. It is suspected of chronic cholecystitis; in some cases, the pain may be caused by overwork or posture change. Increased; if the cyst ruptures can be complicated by inflammation.
Chest X-ray examination showed obvious shadows at the corner of the heart, and the shape and size of the shadows were significantly changed by deep breathing and body position changes.
Examine
Examination of pericardial cysts
Imaging performance
1. X-ray performance:
1 cyst often occurs in the heart area, more common on the right side.
2 The cyst is round or elliptical with uniform density and clear edges.
3 lateral position, the cyst is leaning forward, close to the front chest wall.
4 Under fluoroscopy, changes in chest pressure can cause deformation.
2. CT performance:
The 12/3 pericardial cyst is located in the right heart corner area, and is found in the left heart angle, the back of the heart.
2 lesions are usually connected to the pericardium, but a few with pedicles and no obvious connection with the pericardium.
3 is a single-port cystic mass, round or oval, water sample density, thin and uniform wall, smooth edges, size 2 ~ 16cm, rarely calcified.
4 enhanced examination, no enhancement of lesions.
3. MRI performance:
1 Pericardial cyst is usually located in the right palpebral horn area, a small number in the left palpebral horn area or other parts.
2 lesions are round or oval, with smooth edges.
3 Serous pericardial cysts have long T1 low signal and long T2 high signal, but when the intracapsular protein content is high, it is short T1 high signal.
At the palpitations, especially in the right palpebral horn, a single atrial water-like density mass with a smooth edge can be diagnosed as a pericardial cyst.
Diagnosis
Diagnosis and differentiation of pericardial cyst
diagnosis
Diagnosis can be based on the cause, symptoms and related tests.
Differential diagnosis
The diagnosis of imaging should be differentiated from the following diseases :
1, dermoid cyst
Most of them are located in the anterior mediastinum, with clear outlines and sharp edges, but the density varies from word to line. The CT value is -10~10Hu, and 1/3 to half of the calcification can be seen. The bronchial communication can form a liquid-vapor chamber. Coughing hair, etc., helps to differentiate the diagnosis.
2, bronchial cysts
Occurs around the bronchi and bronchi, circular or elliptical, the water sample density is uniform, the edge is smooth and sharp, and the bronchial passage can change with the size of the breath. If some liquid is contained, the gas-liquid cyst is formed, and the CT density is uniform. The wall of the capsule is thin and the inner edge is smooth, which can cause the pressure of the adjacent trachea or bronchus to be narrowed. The CT value is 30-50 Hu.
3, esophageal cyst
Located in the posterior mediastinum, round or elliptical cystic mass next to the esophagus, the contour is smooth, the wall of the capsule is thicker >4mm, it is muscular soft tissue, the local esophagus can be compressed, and the CT value is about 50Hu.
4, pericardial fat pad
Common in obese people, with more left palpebral angles, no complete contour, lower density than pericardial cysts, lateral slices often show unclear, CT values are negative (-50 Hu or less), MRI to distinguish fat or water The sample is very sensitive and the fat pad appears as a high signal on the SE-sequence TI-WI image.
Clinically, lymphangioma needs to be identified:
Mediastinal cystic lymphangioma is a rare mediastinal benign tumor, accounting for 3.85% of the total mediastinal tumors and cysts. Its formation may be related to the abnormality of lymphatic vessels and body veins leading to lymphatic drainage obstruction, but also from the lymphatic vessels of the neck. The primordium is taken into the chest when the pericardium is lowered, so it can be seen in the mediastinum, mostly in the upper middle part of the anterior mediastinum. The size of the mass is different. It can be single or multi-room or honeycomb, and is divided into a neck-stereotype.-mediastiment type, mediastinal type and neck--mediastiment type 4 types, many without clinical symptoms, especially the mediastinal type is often X-ray examination. Occasionally, most of the chest radiographs show marginal smoothing mediastinal mass, no mediastinal shift CT showed that the mass was cystic, the boundary was clear, and there was no surrounding invasion. The disease was easily misdiagnosed as pericardial cyst. Therefore, it should be strictly diagnosed. The mediastinal cystic lymphangioma is relatively rare, especially the single-room image is not special. Pre-diagnosis is difficult. When a cystic mass occurs in the mediastinum, it should be considered as one of the differential diagnosis to improve the diagnostic accuracy.
