Anesthetic Management of a Patient with a Giant Pericardial Cyst Compressing the Right Atrium

Pericardial cysts are rare, benign congenital mediastinal or cardiodiaphragmatically located cysts which develop secondary to pericarditis, trauma, or infection without communication with pericardial space. Most pericardial cysts are asymptomatic malformations and discovered incidentally which when undetected leads to life-threatening complications like diastolic dysfunction, right ventricular outflow tract obstruction, pulmonary stenosis or congestive heart failure. In this case report we present a 43-year-old female with an asymptomatic 5.5x6.0x6.3 cm pericardial cyst which was incidentally identified as an abnormal cardiac silhouette during routine chest radiography. Chest radiography reports confirmed the presence of a pericardial cyst with compression of the right atrium and ascending aorta. The patient underwent successful thoracoscopic resection of the pericardial cyst under general anesthesia following thoracotomy. The patient’s postoperative course was uneventful and he was discharged on postoperative day 4 in a stable condition. Appropriate mitigation of perioperative challenges associated with the thoracoscopy based resection of pericardial cysts minimizes mortality rate and improve patient outcomes.

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Anesthetic management of patients undergoing mediastinal mass operation

Tan

Lin²,

He³

et al. 2022

Front. Surg.

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ObjectivesTo summarize the anesthetic management of patients undergoing mediastinal mass operation.MethodsElectronic databases were searched to identify all case reports of patients undergoing mediastinal mass operation. Information such as clinical characteristics, perioperative management and patients’ outcomes were abstracted and analyzed.ResultsSeventy-seven case reports with 85 patients aging from 34 days to 81 years were included. Mediastinal masses were located in anterior (n = 48), superior (n = 15), middle (n = 9) and posterior (n = 9) mediastinum, respectively. Clinical manifestations included dyspnea (n = 45), cough (n = 29), chest or radiating pain (n = 12), swelling (n = 8), fever (n = 7) and chest distress (n = 4). Most patients (n = 75) had signs of compression or invasion of vital structures. General anesthesia (n = 76) was the most commonly used method of anesthesia. Muscle relaxants were administered in 35 patients during anesthesia induction and spontaneous respiration was maintained in 37 patients. Mediastinal mass syndrome (MMS) occurred in 39 cases. Extracorporeal circulation was utilized in 20 patients intraoperatively. Three patients experienced cardiac arrest after ventilation failure and two patients died intraoperatively and one postoperatively.ConclusionsPeri-operative management of patients undergoing mediastinal mass operation could be challenging. Pre-operative multi-disciplinary discussion, well-planned anesthetic management and pre-determined protocols for emergency situations are all vital to patient safety.

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Anesthetic Management of a Patient with a Giant Pericardial Cyst Compressing the Right Atrium

Cited by 3 publications

References 27 publications

Anesthetic and surgical considerations of giant pericardial cyst: Case report and literature review

Anesthetic and surgical considerations of giant pericardial cyst: Case report and literature review

Pericardial cyst compressing right atrium and ascending aorta – anesthetic management case report

Anesthetic management of patients undergoing mediastinal mass operation

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