·         Fluid-filled cysts of the parietal pericardium consisting of a single layer of mesothelial cells

·         Usually discover at age 30-40 years, predominantly in males (3:2)

·         Most are asymptomatic and incidental findings

·         Atypical chest pain can occur

·         They are usually (75%) located at the cardiophrenic angle almost always on the right (3:1)

o       DDX of a right cardiophrenic angle mass

§         Pericardial cyst

§         Sequestration

§         Foramen of Morgagni hernia

·         They can occur higher and may extend into major fissure

o       Classically they are soft and can be flattened on the edge that faces the fissure

·         They rarely occur in the mediastinum

·         Imaging findings

 

Pericardial Cyst. Frontal and lateral views of the chest demonstrate a mass at the right cardiophrenic angle with rim-like calcification that indicates the calcification has formed in the wall of a hollow viscus. This is a characteristic location for a pericardial cyst, which is calcified in this case.
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o       Sharply marginated

o       Round or oval mass

o       From 3-8 cm in size usually

o       They can change in size and shape with respiration or body position

o       Rarely calcify

·         On CT, their attenuation values of 20-40 HU, occasionally higher