“Atrial fibrillation as initial symptom of an intrapericardial bronchogenic cyst”

Abstract

A 73-year-old female presented to the emergency department with hemodynamic instability due to rapid atrial fibrillation (AF). She had been operated through a right thoracotomy, twice in the past, for bronchogenic cyst resection situated at the subcarinal space.Echocardiography showed a cysts-like structure inside the pericardial cavity, compressing the left atrium. Further investigation with computed tomography-scan and magnetic resonance imaging clarified the margins of the lesion. It was located in the posterior parietal pericardium between the origin of the superior pulmonary veins and showed no myocardial invasion (Figures 1 and 2).After standard median sternotomy and cardiopulmonary bypass, the cystic structure was accessed. After mobilizing the cyst from the left atrium, and the pulmonary veins it could be en bloc resected (Figure 3). The patient had an uneventful recovery and she is free of AF and other symptoms 28 months later.Histopathology confirmed the diagnosis of bronchogenic cyst excluding any malignancy.Bronchogenic cysts are the most common congenital cystic lesions of the mediastinum and are derived from the primitive foregut. They also occur in the lungs, diaphragm, retroperitoneum, thymus, neck, and very rare in the pericardium with an incidence of 1:42 000 patients. Patients with intrapericardial bronchogenic cysts may present with mild or moderate symptoms that include shortness of breath and chest pain, sometimes in association with arrhythmia.