A symptomatic calcified pericardial cyst
The present case has been reported in the recent issue of Mayo Clinic Proceedings.

The authors describe a 59-year-old man with a large calcified pericardial cyst who presented with recurrent spells of presyncope and dyspnea. Presyncope occurred on several occasions and was confined to when the patient was walking. Dyspnea occurred in the supine and semirecumbent positions and unpredictably during walking, especially when in a hot or humid environment.

Electrocardiography showed resting sinus bradycardia and nonspecific ST- and T-wave changes. Chest radiography revealed a peripherally calcified spherical mass near the right cardiophrenic angle. On subsequent echocardiography, a nonperfusing extracardiac mass was seen anterior to the right atrium. This mass compressed the main body of the right atrium and, to a lesser extent, the junction of the superior vena cava. The velocity of superior vena cava flow increased with Valsalva maneuver with the patient supine, a suggestion of an increase in obstruction under these conditions.

Given that most pericardial cysts are asymptomatic, a workup was performed to determine whether the patient’s atypical symptoms were related. Thoracic computed tomography further characterized the mass as heavily calcified with a radiolucent center measuring approximately 6.5 cm in maximal diameter.

The patient was referred for surgery and underwent a pericardectomy with removal of the mass. Histopathologic examination of the mass identified no neoplastic or infectious features, and a calcified pericardial cyst with extensive hemorrhage and degeneration was diagnosed. The patient was discharged after 2 days, and the rest of the postoperative course was uneventful. The initial symptoms of dyspnea and presyncope resolved after the procedure.

Major takeaway:-
- Although pericardial cysts are usually asymptomatic, symptoms can occur from compression of surrounding mediastinal structures, as in this patient.

- Other common symptoms, in decreasing order, include chest pain, dyspnea, persistent cough, and persistent atrial tachycardia.

- Syncope caused solely by a pericardial cyst is rare. In the case described, the presyncope was thought to be due to positional compression of the right atrium.

Know more here: https://www.mayoclinicproceedings.org/article/S0025-6196(18)30924-8/fulltex