A case of pericardial cyst?
A young woman who hospitalized because of breathing difficulty. On X ray film we found that left border of the heart was protruding abnormally. But we could not diagnose exactly what happened to her heart actually? But on CT scanner, as you can see, the enormous lesion is oval, well-defined, very thin-walled, nonenhancing near-water-density mass. Characteristic location is next to the carina but it also originated very close to pericardium actually, protruding toward the right and calcified wall. Most common in the middle mediastinum, but may occur in the posterior and occasionally in the anterior mediastinum. May contain viscous material and have a density up to 60 HU. But does not enhance.
According to the Differential diagnosis in Computed Tomography book, pericardial cyst with the following characters: Round smooth thin-walled nonenhancing mass of near-water density, most commonly located in the right cardiophrenic angle (middle or anterior mediastinum). May change shape when the patient is turned from supine to prone. Usually asymptomatic. Water density differentiates pericardial cyst from lipomas and fat pads, which also present as cardiophrenic angle masses. So the first diagnosis must be a pericardial cyst and the differential diagnosis may be a bronchial cyst i suppose.
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