Elsevier

Progress in Cardiovascular Diseases

Volume 59, Issue 4, January–February 2017, Pages 389-397
Progress in Cardiovascular Diseases

Pericardial Masses, Cysts and Diverticula: A Comprehensive Review Using Multimodality Imaging

https://doi.org/10.1016/j.pcad.2016.12.011Get rights and content

Abstract

Pericardial masses/tumors, cysts, and diverticula are quite rare. Presentation is variable and often patients may be asymptomatic with pericardial involvement initially only detected at time of autopsy. When patients do present with symptoms they are often non-specific and often mimic other conditions of the pericardium such as pericarditis, pericardial effusion, constriction or tamponade. Therefore, echocardiography and cross-sectional imaging are essential in identifying and characterizing pericardial disease. Imaging findings vary in specificity depending on the type of tumor. The purpose of this review is to describe the role of multi-modality imaging and characteristic findings in patients with pericardial masses/tumors, cysts, and diverticula.

Section snippets

Pericardial tumors

Overall incidence of cardiac and pericardial tumors is low and has been shown to be 1–3 per 10,000 patients in autopsy series.7., 8., 9. Tumors in the pericardium can additionally be divided into primary or metastatic in origin. Metastatic tumors of the pericardium are more common than primary tumors, with estimated incidence from autopsy studies ranging widely from 20 to 1000 times more likely.8., 9., 10., 11. Due to the rarity of these tumors, initial data were in the form of case reports and

Pericardial cysts and diverticula

Pericardial cysts are rare, benign congenital malformations with an incidence of approximately 1 in 100,00063 which comprise about 7% of mediastinal masses.64 Both pericardial cysts and diverticula are due to abnormal fusion or lack of fusion of mesenchymal lacunae though diverticula retain communication with the pericardial space.65., 66., 67., 68., 69. It appears that cysts are more common than diverticula with one series reporting a relative ratio of 3:1.70 Diverticula may be distinguished

Conclusions

Pericardial masses in the form of tumors, thrombus, cysts and diverticula are rare, but important sources of morbidity and mortality. Patients may be asymptomatic with disease found incidentally on imaging, or present with a wide-variety of symptoms including chest pain, dyspnea or palpitations. Echocardiography is an important initial study for the detection of pericardial masses and associated effusions, as well as hemodynamic compromise; however often cross-sectional imaging is required for

Statement of Conflict of Interest

None of the authors have any conflicts of interests with regard to this publication.

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    Statement of conflict of interest: see page 395.

    Disclosures: None.

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