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Thoracoscopic Resection of a Pericardial Cyst with Cardiac Tamponade and Pleural Bloody Effusion Hiroyuki Oda 1 , Kouji Kubota 1 , Masaki Okajima 1 , Masao Yagi 2 , Hiroyuki Takamura 2 , Manabu Akimoto 3 , Shioto Suzuki 4 1Department of Cardiovascular Medicine, Public Central Hospital of Mattou-Ishikawa 2Department of Surgery, Public Central Hospital of Mattou-Ishikawa 3Department of Radiology, Public Central Hospital of Mattou-Ishikawa 4First Department of Pathology, Kanazawa University Keyword: 心膜嚢胞 , 心タンポナーデ , 胸腔鏡下嚢胞切除術 , pericardial cyst , cardiac tamponade , thoracoscopic resection pp.495-500
Published Date 2001/5/15
DOI https://doi.org/10.11477/mf.1404902292
  • Abstract
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 A 55-year-old female with no significant previoushistory was admitted to our hospital because of dyspneaon exercise. Physical findings, demonstrated right-sided heart failure with dilated neck vein, hepatomegaly andperipheral edema. Her temperature was 37.0℃, bloodpressure was 98/60mmHg, pulse was 92/min (irreg.) andheart sounds were distant. On laboratory data, it wasshown that transaminase and ductal enzyme were elevated. Chest radiograph showed cardiomegaly with adilated right atrium. Echocardiography revealed moderate pericardial effusion and a pericardial mass. Computed tomographic scan showed a well defined cyst in theright cardiophrenic angle which was in contact with thepericardium and parietal pleura. In MRI and Ga scan,we suspected the mass was an inflammatory cysticlesion. In the clinical course, the patients symptomswere progressive with massive pleural effusion. Todetermine diagnosis, we tried puncture of both pleuraland pericardial effusions. Both effusions were bloodyand CAl25 in the tumor marker was elevated, so wecould not ignore the possibility of a malignant cysticlesion and carried out thoracoscopic surgical resectionof the cyst as a minimally invasive procedure. The cystwith adhesion of parietal pleura was completelyremoved and cardiac tamponade lessened. In histopathological findings, the cyst size was 3.6×2.0×0.8cm andthe cyst wall was composed of lined mesothelium, collagen with adipose tissue and accumulations oflympocytes. These data confurined our preoperativededuction that cardiac tamponade and pleural effusionwere induced by a inflammatory pericardial cyst. Weconsider thoracoscopic surgical resection to be themethod of choice, when a pericardial cyst is identifiableas such or when differential diagnosis is difficult, as wasthe case in this instance.


Copyright © 2001, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1200 印刷版ISSN 0452-3458 医学書院

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