Symptomatic Pericardial Cyst with a Mass Effect on the Right Heart

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On average, they have a diameter of 5.4 cm and are rarely symptomatic. It is even more rare for pericardial cysts to be greater than 10 cm in diameter, which are preferentially excised via an open approach. There is limited literature on video-assisted thorascopic surgery (VATS) for giant symptomatic pericardial cysts. We present the case of a 66-year-old with a symptomatic pericardial cyst and coexisting loculated pleural effusion successfully treated with VATS excision. Case Description: Our patient presented with worsening shortness of breath and yellow-sputum production. Work-up revealed a 12.3 x 10.9 x 6.8 cm pericardial cyst with mass effect on the right atrium and ventricle. He underwent a right robotic assisted (VATS). He required pneumolysis for adequate exposure of the pericardium because of loculated pleural effusion. Excision was performed with electrocautery along the rim of the cyst for decompression and resection. The patient's hemodynamics remained stable throughout the procedure Conclusions: For our patient, VATS was a safe and effective approach for resecting a pericardial cyst. There is limited reporting giant pericardial cysts resected via a VATS approach in patients with challenging anatomic exposure secondary to loculations. This supports VATS for excision of giant symptomatic pericardial cysts, including in select patients with an anatomically hostile thoracic cavity. Pericardial cyst VATs Pneumolysis Figures Figure 1 Introduction Pericardial cysts constitute 6–7% of masses in the mediastinum, with an incidence of 1:100,00 [1]. In some patients, they can originate congenitally from an embryological weakness in the pericardial sac, resulting in herniation. Other risk factors include inflammatory disease, cardiac trauma, or infection [4]. Typically, asymptomatic, pericardial cysts are on average 5.4 cm in diameter [5]. It is rare for patients to have symptoms secondary to pericardial cysts and even more uncommon for pericardial cysts to be greater than 10 cm in diameter, which are classified as giant [3]. For symptomatic cysts, intervention, including aspiration and open or thoracoscopic excision, is warranted. Giant cysts pose a unique therapeutic challenge, especially when they are abutting critical structures in the mediastinum. As a result, they are preferentially excised via an open approach [3]. There are few studies reporting the efficacy of a VATS approach for treating giant symptomatic pericardial cysts. We present the case of a 66-year-old patient with a symptomatic pericardial cyst and coexisting loculated pleural effusion that was successfully treated with VATS excision. Case A 66-year-old male presented with worsening shortness of breath and yellow sputum production. The work-up included computed tomography, which revealed a 12.3 × 10.9 × 6.8 cm pericardial cyst with a mass effect on the right atrium and ventricle. He had a history of hypertension, rheumatoid arthritis, and chronic obstructive pulmonary disease (COPD), which contributed to his dyspnea at baseline. Four years prior to presentation, the patient was treated for right loculated pleural effusion with antibiotics and chest tube placement. CT imaging during the previous admission did not reveal any evidence of a pericardial cyst. Further workup included an echocardiogram, which revealed a dilated right ventricle and an ejection fraction of 55%. Given his symptomatic presentation and imaging findings of a giant pericardiac cyst with a mass effect, excision was planned. Cardiology recommended catheterization for cardiac clearance prior to surgery, which revealed nonobstructive coronary artery disease. Echo revealed normal cardiac function with an EF of 55% along with a dilated right ventricle. After cardiac optimization, the patient underwent right robotic video-assisted thoracoscopic surgery (VATS). The entire right chest had adhesions throughout the right upper, middle and lower lobes. Extensive lysis of adhesions was performed to allow mobility and visibility to eventually identify the pericardium and the phrenic nerve. The pericardial cyst bulging outward was visualized and correlated with the preoperative imaging at this location. The cyst excision was performed via electrocautery, where a full large rim of the cyst was removed and decompressed. Upon decompression, the patient's hemodynamics remained stable, and the pericardial cyst was sent for pathology for further evaluation. A 20-French chest tube was placed to allow the right upper, middle and lower lobes to expand. The patient’s postoperative course was complicated by hyponatremia, which was treated with fluid restriction. His chest tube was removed on postoperative day (POD) 3, and he was discharged on POD 4. Pathology revealed dense fibrous tissue compatible with the capsule of the pericardial cyst. Discussion Pericardial cysts are uncommon and are diagnosed as an incidental finding in 75% of cases [5]. It is even rarer to present with symptoms and a size greater than 10 cm. When symptomatic, patients present with nonspecific complaints, including dyspnea and/or chest pain, and occasionally radiation to the shoulder. Complications arise from compression of surrounding structures, such as atrial fibrillation, right ventricular diastolic dysfunction, pulmonary artery stenosis, and mitral valve prolapse [7]. They most typically present along the right cardiac border, near the cardiophrenic angle, similar to our patient [6]. CT imaging 4 years prior to diagnosis did not reveal evidence of a cyst in our patient, suggesting that its development may have been secondary to an inflammatory process, including the patient’s history of rheumatoid arthritis and loculated pleural effusion. There is minimal reporting of pericardial cysts undetected on prior imaging [8]. For symptomatic cysts, resection is generally warranted. Aspiration is an option in patients who are symptomatic and awaiting surgery or who are poor surgical candidates but can be associated with a 33% risk of recurrence [7]. Surgical options included VATs, thoracotomy, or sternotomy. Traditionally, large cysts are resected via an open approach because they are more likely to compress surrounding critical structures. In our patient, the cyst was safely resected with VATS, which still permitted intraoperative pneumolysis for adhesions related to his coexisting loculated pleural effusion. There are few reported cases involving VATS for the resection of giant pericardial cysts [10, 3, 9]. Our case is particularly unique because a VATS approach was successful used to resected a giant pericardial cyst in a patient with loculated pleural effusion requiring pneumolysis for adequate exposure of the pericardium. This finding supports the use of VATS for the excision of giant symptomatic pericardial cysts, including in patients with an anatomically hostile thoracic cavity. Conclusion Giant and symptomatic pericardial cysts are rare mediastinal masses that should be resected. VATS is a safe and effective approach for the resection of giant symptomatic pericardial cysts in select patients, including those requiring complicated anatomical exposure. More research is needed on the efficacy of different operative techniques for the treatment of this condition. Abbreviations VATS; POD; CT Declarations Ethics approval and consent to participate: The HCA Florida JFK Hospital has provided written approval for writing and publication (Manuscript number 3726) of this case report. Consent for publication: Signed consent has been obtained from the patient for publication of this case report. Availability of data and materials: The data underlying this article cannot be shared publicly for the privacy of individuals that participated in the study. The data will be shared on reasonable request to the corresponding author. Competing interests: There are no conflicts of interest to disclose Funding: There were no sources of funding for this study. Author contributions: Nicholas Borden, MD contributed to preparation, creation and/or presentation of the published work, specifically writing the initial draft. Chadi Nahal, MD and Eric Johnson, MD contributed to preparation, creation and/or presentation of the published work by those from the original research group, specifically critical review, commentary or revision – including pre- or post-publication stages. Marcus Eby, MD contributed to oversight and leadership responsibility for the research activity planning and execution, including mentorship external to the core team and preparation, creation and/or presentation of the published work by those from the original research group, specifically critical review, commentary or revision – including pre- or post-publication stages. References J. Rychik, D.A. Piccoli, G. Barber, Usefulness of corticosteroid therapy for proteinlosing enteropathy after the Fontan procedure, Am. J. Cardiol. 68 (1991) 819–821. Davis RD, Oldham HN, Sabiston DC. Primary cysts and neoplasms of the mediastinum: recent changes in clinical presentation, methods of diagnosis, management, and results. Ann Thorac Surg. 1987 Sep;44(3):229-37. Ugwu J, Hamilton R, Taskesen T, Osei K, Ghali M. A rapidly enlarging giant pericardial cyst resected by video-assisted thoracoscopic surgery (VATS): A case report. J Cardiol Cases. 2021 Nov 20;25(4):234-236. doi: 10.1016/j.jccase.2021.10.006. PMID: 35911074; PMCID: PMC9326006. Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J, Brucato A, Gueret P, Klingel K, Lionis C, Maisch B, Mayosi B, Pavie A, Ristic AD, M Sabaté Tenas, et al. 2015 ESC guidelines for the diagnosis and management of pericardial diseases: The task force for the diagnosis and management of pericardial diseases of the european society of cardiology (ESC)endorsed by: the European association for cardio-thoracic surgery Parmar YJ, Shah AB, Poon M, Kronzon I. Congenital Abnormalities of the Pericardium. Cardiol Clin. 2017 Nov;35(4):601-614. Stoller JK, Shaw C, Matthay RA. An enlarging, atypically located pericardial cyst. Recent experience and literature review. Chest. 1986 Mar;89(3):402-6 Kar SK, Ganguly T. Current concepts of diagnosis and management of pericardial cysts. Indian Heart J. 2017 May-Jun;69(3):364-370 Comoglio C, Sansone F, Delsedime L, Campanella A, Ceresa F, Rinaldi M. Mesothelial cyst of the pericardium, absent on earlier computed tomography. Tex Heart Inst J. 2010;37(3):354-7. PMID: 20548822; PMCID: PMC2879185. Taguchi E, Oshitomi T, Kamio T, Sakamoto T. Surgical resection of a giant pericardial cyst: a case report. Eur Heart J Case Rep. 2021 Apr 12;5(4):ytab 116. doi: 10.1093/ehjcr/ytab 116. PMID: 34124550; PMCID: PMC8188873. Alqassieh R, Al-Balas M, Al-Balas H. Anesthetic and surgical considerations of giant pericardial cyst: Case report and literature review. Ann Med Surg (Lond). 2020 Jun 3;55:275-279. doi: 10.1016/j.amsu.2020.05.038. PMID: 32547739; PMCID: PMC7286924. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 03 Nov, 2025 Read the published version in Journal of Cardiothoracic Surgery → Version 1 posted Editorial decision: Revision requested 01 Jul, 2025 Reviews received at journal 10 Jun, 2025 Reviews received at journal 08 Jun, 2025 Reviewers agreed at journal 08 Jun, 2025 Reviewers agreed at journal 07 Jun, 2025 Reviews received at journal 04 Jun, 2025 Reviewers agreed at journal 04 Jun, 2025 Reviewers agreed at journal 02 Jun, 2025 Reviewers invited by journal 02 Jun, 2025 Editor assigned by journal 24 Mar, 2025 Submission checks completed at journal 24 Mar, 2025 First submitted to journal 22 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6285621","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":465432021,"identity":"3c79b7b0-c741-4d95-8d2b-7749b1cac787","order_by":0,"name":"Nicholas Borden","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyklEQVRIiWNgGAWjYFACHvaPHyr+y4GYBx4QqYWNWeIMszFYSwKxWhh425gTG0BsorSYs5899kCCjS19ftjhh0Bb7OR0GwhosezJSzco4OHJ3Xg7zQCoJdnY7AABLQYHcgwkgCB34+wEkJYDidsIajn/xkCCx8Ag3XB2+gcitdzIMZPgSUhIkJfOIdaWG++SjSUOHDDcIJ1TcCDBgBi/nM89+PDjvwPy8rPTN3/4UGEnR1ALQi9YpQGxykFAvoEU1aNgFIyCUTCiAABMkkclRZwGXAAAAABJRU5ErkJggg==","orcid":"","institution":"John F. Kennedy Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Nicholas","middleName":"","lastName":"Borden","suffix":""},{"id":465432023,"identity":"88e748c6-93ff-41a5-87a6-71077dc7708e","order_by":1,"name":"Chadi Nahal","email":"","orcid":"","institution":"John F. Kennedy Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Chadi","middleName":"","lastName":"Nahal","suffix":""},{"id":465432025,"identity":"392265da-17b3-4270-a522-ca2bcc53c356","order_by":2,"name":"Eric Johnson","email":"","orcid":"","institution":"John F. Kennedy Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Eric","middleName":"","lastName":"Johnson","suffix":""},{"id":465432027,"identity":"5aa1cfc0-6b80-4f31-8c95-9e8faa2c37c0","order_by":3,"name":"Marcus Eby","email":"","orcid":"","institution":"John F. Kennedy Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Marcus","middleName":"","lastName":"Eby","suffix":""}],"badges":[],"createdAt":"2025-03-22 22:23:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6285621/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6285621/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13019-025-03659-5","type":"published","date":"2025-11-03T15:56:55+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":84186135,"identity":"b1c73145-f88f-451d-a5d5-3e718e02ca6f","added_by":"auto","created_at":"2025-06-09 05:37:25","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":185796,"visible":true,"origin":"","legend":"\u003cp\u003eCross-sectional image of a pericardial cyst upon presentation measuring 12.3 × 10.9 × 6.8 cm.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6285621/v1/c80b9ce341a5d12763cfb8e8.png"},{"id":95564810,"identity":"57c977ac-6452-4510-95ca-21e34c8498c0","added_by":"auto","created_at":"2025-11-10 16:10:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":428995,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6285621/v1/d8568ae5-0965-40fa-868c-2965d31defd5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Symptomatic Pericardial Cyst with a Mass Effect on the Right Heart","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePericardial cysts constitute 6–7% of masses in the mediastinum, with an incidence of 1:100,00 [1]. In some patients, they can originate congenitally from an embryological weakness in the pericardial sac, resulting in herniation. Other risk factors include inflammatory disease, cardiac trauma, or infection [4]. Typically, asymptomatic, pericardial cysts are on average 5.4 cm in diameter [5]. It is rare for patients to have symptoms secondary to pericardial cysts and even more uncommon for pericardial cysts to be greater than 10 cm in diameter, which are classified as giant [3]. For symptomatic cysts, intervention, including aspiration and open or thoracoscopic excision, is warranted. Giant cysts pose a unique therapeutic challenge, especially when they are abutting critical structures in the mediastinum. As a result, they are preferentially excised via an open approach [3]. There are few studies reporting the efficacy of a VATS approach for treating giant symptomatic pericardial cysts. We present the case of a 66-year-old patient with a symptomatic pericardial cyst and coexisting loculated pleural effusion that was successfully treated with VATS excision.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Case","content":"\u003cp\u003eA 66-year-old male presented with worsening shortness of breath and yellow sputum production. The work-up included computed tomography, which revealed a 12.3 × 10.9 × 6.8 cm pericardial cyst with a mass effect on the right atrium and ventricle. He had a history of hypertension, rheumatoid arthritis, and chronic obstructive pulmonary disease (COPD), which contributed to his dyspnea at baseline. Four years prior to presentation, the patient was treated for right loculated pleural effusion with antibiotics and chest tube placement. CT imaging during the previous admission did not reveal any evidence of a pericardial cyst. Further workup included an echocardiogram, which revealed a dilated right ventricle and an ejection fraction of 55%. Given his symptomatic presentation and imaging findings of a giant pericardiac cyst with a mass effect, excision was planned. Cardiology recommended catheterization for cardiac clearance prior to surgery, which revealed nonobstructive coronary artery disease. Echo revealed normal cardiac function with an EF of 55% along with a dilated right ventricle. After cardiac optimization, the patient underwent right robotic video-assisted thoracoscopic surgery (VATS). The entire right chest had adhesions throughout the right upper, middle and lower lobes. Extensive lysis of adhesions was performed to allow mobility and visibility to eventually identify the pericardium and the phrenic nerve. The pericardial cyst bulging outward was visualized and correlated with the preoperative imaging at this location. The cyst excision was performed via electrocautery, where a full large rim of the cyst was removed and decompressed. Upon decompression, the patient's hemodynamics remained stable, and the pericardial cyst was sent for pathology for further evaluation. A 20-French chest tube was placed to allow the right upper, middle and lower lobes to expand.\u003c/p\u003e\n\u003cp\u003eThe patient’s postoperative course was complicated by hyponatremia, which was treated with fluid restriction. His chest tube was removed on postoperative day (POD) 3, and he was discharged on POD 4. Pathology revealed dense fibrous tissue compatible with the capsule of the pericardial cyst.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePericardial cysts are uncommon and are diagnosed as an incidental finding in 75% of cases [5]. It is even rarer to present with symptoms and a size greater than 10 cm. When symptomatic, patients present with nonspecific complaints, including dyspnea and/or chest pain, and occasionally radiation to the shoulder. Complications arise from compression of surrounding structures, such as atrial fibrillation, right ventricular diastolic dysfunction, pulmonary artery stenosis, and mitral valve prolapse [7]. They most typically present along the right cardiac border, near the cardiophrenic angle, similar to our patient [6]. CT imaging 4 years prior to diagnosis did not reveal evidence of a cyst in our patient, suggesting that its development may have been secondary to an inflammatory process, including the patient’s history of rheumatoid arthritis and loculated pleural effusion. There is minimal reporting of pericardial cysts undetected on prior imaging [8]. For symptomatic cysts, resection is generally warranted. Aspiration is an option in patients who are symptomatic and awaiting surgery or who are poor surgical candidates but can be associated with a 33% risk of recurrence [7]. Surgical options included VATs, thoracotomy, or sternotomy. Traditionally, large cysts are resected via an open approach because they are more likely to compress surrounding critical structures. In our patient, the cyst was safely resected with VATS, which still permitted intraoperative pneumolysis for adhesions related to his coexisting loculated pleural effusion. There are few reported cases involving VATS for the resection of giant pericardial cysts [10, 3, 9]. Our case is particularly unique because a VATS approach was successful used to resected a giant pericardial cyst in a patient with loculated pleural effusion requiring pneumolysis for adequate exposure of the pericardium. This finding supports the use of VATS for the excision of giant symptomatic pericardial cysts, including in patients with an anatomically hostile thoracic cavity.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eGiant and symptomatic pericardial cysts are rare mediastinal masses that should be resected. VATS is a safe and effective approach for the resection of giant symptomatic pericardial cysts in select patients, including those requiring complicated anatomical exposure. More research is needed on the efficacy of different operative techniques for the treatment of this condition.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eVATS; POD; CT\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cu\u003eEthics approval and consent to participate:\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe HCA Florida JFK Hospital has provided written approval for writing and publication (Manuscript number 3726) of this case report.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eConsent for publication:\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eSigned consent has been obtained from the patient for publication of this case report.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAvailability of data and materials:\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe data underlying this article cannot be shared publicly for the privacy of individuals that participated in the study. The data will be shared on reasonable request to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eCompeting interests:\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThere are no conflicts of interest to disclose\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eFunding:\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThere were no sources of funding for this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAuthor contributions:\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eNicholas Borden, MD contributed to preparation, creation and/or presentation of the published work, specifically writing the initial draft. Chadi Nahal, MD and Eric Johnson, MD contributed to preparation, creation and/or presentation of the published work by those from the original research group, specifically critical review, commentary or revision – including pre- or post-publication stages. Marcus Eby, MD contributed to oversight and leadership responsibility for the research activity planning and execution, including mentorship external to the core team and preparation, creation and/or presentation of the published work by those from the original research group, specifically critical review, commentary or revision – including pre- or post-publication stages.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eJ. Rychik, D.A. Piccoli, G. Barber, Usefulness of corticosteroid therapy for proteinlosing enteropathy after the Fontan procedure, Am. J. Cardiol. 68 (1991) 819\u0026ndash;821.\u003c/li\u003e\n\u003cli\u003eDavis RD, Oldham HN, Sabiston DC. Primary cysts and neoplasms of the mediastinum: recent changes in clinical presentation, methods of diagnosis, management, and results. Ann Thorac Surg.\u0026nbsp;1987 Sep;44(3):229-37.\u003c/li\u003e\n\u003cli\u003eUgwu J, Hamilton R, Taskesen T, Osei K, Ghali M. A rapidly enlarging giant pericardial cyst resected by video-assisted thoracoscopic surgery (VATS): A case report. J Cardiol Cases. 2021 Nov 20;25(4):234-236. doi: 10.1016/j.jccase.2021.10.006. PMID: 35911074; PMCID: PMC9326006.\u003c/li\u003e\n\u003cli\u003eAdler Y, Charron P, Imazio M, Badano L, Bar\u0026oacute;n-Esquivias G, Bogaert J, Brucato A, Gueret P, Klingel K, Lionis C, Maisch B, Mayosi B, Pavie A, Ristic AD, M Sabat\u0026eacute; Tenas, et al. 2015 ESC guidelines for the diagnosis and management of pericardial diseases: The task force for the diagnosis and management of pericardial diseases of the european society of cardiology (ESC)endorsed by: the European association for cardio-thoracic surgery\u003c/li\u003e\n\u003cli\u003eParmar YJ, Shah AB, Poon M, Kronzon I. Congenital Abnormalities of the Pericardium. Cardiol Clin.\u0026nbsp;2017 Nov;35(4):601-614.\u003c/li\u003e\n\u003cli\u003eStoller JK, Shaw C, Matthay RA. An enlarging, atypically located pericardial cyst. Recent experience and literature review.\u0026nbsp;Chest. 1986 Mar;89(3):402-6\u003c/li\u003e\n\u003cli\u003eKar SK, Ganguly T. Current concepts of diagnosis and management of pericardial cysts. Indian Heart J.\u0026nbsp;2017 May-Jun;69(3):364-370\u003c/li\u003e\n\u003cli\u003eComoglio C, Sansone F, Delsedime L, Campanella A, Ceresa F, Rinaldi M. Mesothelial cyst of the pericardium, absent on earlier computed tomography. Tex Heart Inst J. 2010;37(3):354-7. PMID: 20548822; PMCID: PMC2879185.\u003c/li\u003e\n\u003cli\u003eTaguchi E, Oshitomi T, Kamio T, Sakamoto T. Surgical resection of a giant pericardial cyst: a case report. Eur Heart J Case Rep. 2021 Apr 12;5(4):ytab 116. doi: 10.1093/ehjcr/ytab 116. PMID: 34124550; PMCID: PMC8188873.\u003c/li\u003e\n\u003cli\u003e Alqassieh R, Al-Balas M, Al-Balas H. Anesthetic and surgical considerations of giant pericardial cyst: Case report and literature review. Ann Med Surg (Lond). 2020 Jun 3;55:275-279. doi: 10.1016/j.amsu.2020.05.038. PMID: 32547739; PMCID: PMC7286924.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Pericardial cyst, VATs, Pneumolysis ","lastPublishedDoi":"10.21203/rs.3.rs-6285621/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6285621/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e Pericardial cysts comprise 6-7% of mediastinal masses. On average, they have a diameter of 5.4 cm and are rarely symptomatic. It is even more rare for pericardial cysts to be greater than 10 cm in diameter, which are preferentially excised via an open approach. There is limited literature on video-assisted thorascopic surgery (VATS) for giant symptomatic pericardial cysts. We present the case of a 66-year-old with a symptomatic pericardial cyst and coexisting loculated pleural effusion successfully treated with VATS excision.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase Description:\u003c/strong\u003e Our patient presented with worsening shortness of breath and yellow-sputum production. Work-up revealed a 12.3 x 10.9 x 6.8 cm pericardial cyst with mass effect on the right atrium and ventricle. He underwent a right robotic assisted (VATS). He required pneumolysis for adequate exposure of the pericardium because of loculated pleural effusion. Excision was performed with electrocautery along the rim of the cyst for decompression and resection. \u0026nbsp;The patient's hemodynamics remained stable throughout the procedure\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e For our patient, VATS was a safe and effective approach for resecting a pericardial cyst. There is limited reporting giant pericardial cysts resected via a VATS approach in patients with challenging anatomic exposure secondary to loculations. This supports VATS for excision of giant symptomatic pericardial cysts, including in select patients with an anatomically hostile thoracic cavity.\u003c/p\u003e","manuscriptTitle":"Symptomatic Pericardial Cyst with a Mass Effect on the Right Heart","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-09 05:37:20","doi":"10.21203/rs.3.rs-6285621/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-01T13:31:30+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-10T15:40:12+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-08T22:59:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"55126683328299504083165253408345728352","date":"2025-06-08T16:20:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"294916161101187746034658987031561888267","date":"2025-06-07T20:28:10+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-04T20:14:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"161890425123740201614994269059675105806","date":"2025-06-04T19:22:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"67214969012421562169514460414299956267","date":"2025-06-02T15:09:37+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-02T14:53:20+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-24T10:27:39+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-24T10:25:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Cardiothoracic Surgery","date":"2025-03-22T22:20:47+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-cardiothoracic-surgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"jcts","sideBox":"Learn more about [Journal of Cardiothoracic Surgery](http://cardiothoracicsurgery.biomedcentral.com)","snPcode":"13019","submissionUrl":"https://submission.nature.com/new-submission/13019/3","title":"Journal of Cardiothoracic Surgery","twitterHandle":"@BioMedCentral","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"45776b80-e834-4b8e-85e2-a43cb36df0bc","owner":[],"postedDate":"June 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-10T16:09:37+00:00","versionOfRecord":{"articleIdentity":"rs-6285621","link":"https://doi.org/10.1186/s13019-025-03659-5","journal":{"identity":"journal-of-cardiothoracic-surgery","isVorOnly":false,"title":"Journal of Cardiothoracic Surgery"},"publishedOn":"2025-11-03 15:56:55","publishedOnDateReadable":"November 3rd, 2025"},"versionCreatedAt":"2025-06-09 05:37:20","video":"","vorDoi":"10.1186/s13019-025-03659-5","vorDoiUrl":"https://doi.org/10.1186/s13019-025-03659-5","workflowStages":[]},"version":"v1","identity":"rs-6285621","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6285621","identity":"rs-6285621","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}