Epicardial Cysts: Report of Two Rare Cases

Abstract

Epicardial cysts originating directly from the epicardium are seen very rarely. Complete surgical excision is recommended when these cysts are detected. If cysts compress surrounding vital structures, cardiopulmonary bypass (CPB) should also be considered. We report herein 2 cases of multiloculated epicardial cysts, both of which were successfully excised, 1 with CPB.

Off-pump resection of a giant inflamed epicardial cyst

“…Coronary CT or angiography might be considered to obtain more information, especially with regard to the degree of adhesion and location of the coronary vessels. When coronary CT shows the involvement of coronary vessels, the need for coronary artery bypass grafting or CPB to resect the cyst should be anticipated; however, coronary CT and angiography may not always exclude the possibility of the involvement of coronary vessels preoperatively because some literature reported epicardial cysts with involvement of the coronary vessels and CPB requirement to resect those cysts despite negative findings on coronary CT or angiography [ 2 – 4 ]. Considering the incidence of the disease, we suspected that the cyst was more likely a pericardial cyst than an epicardial cyst.…”

“…Resection of an epicardial or a pericardial cyst should be considered when the cyst is symptomatic or infected or when it compresses other structures [ 3 , 4 ]. To prevent these events, some authors suggest that these cysts should be resected even if they are asymptomatic [ 2 – 5 ].…”

An Epicardial Mesothelial Cyst Attached to the Ascending Aorta

“…An epicardial mesothelial cyst, which can be defined as a mesothelial cyst attached to the epicardium surrounding the heart and great vessels inside the pericardial sac, is an extremely rare condition [Omeroglu 2004] . To our knowledge, only nine cases with a clear pathological documentation of mesothelial cell origin have been reported to date [Beirne 1954;Debus 2001;Edwards 1972;Hatemi 2012;Komeda 1985;Omeroglu 2004;Ozasa 1991;Scrofani 2002]. Epicardial cysts are histologically identical to pericardial mesothelial cysts, which are much more common.…”

“…We herein report a case of epicardial cyst, which was attached to the ascending aorta. To our knowledge, only nine cases with clear documentation of mesothelial cell origin have been reported to date [Beirne 1954;Debus 2001;Edwards 1972;Hatemi 2012;Komeda 1985;Omeroglu 2004;Ozasa 1991;Scrofani 2002] and the attachment to the ascending aorta has never been reported before.…”

Epicardial Cyst Originating from Right Ventricle

“…In our case, the cyst appeared to be a mass before surgery. Many authors have noted that solid tumors, such as bronchogenic cyst, lymphoma, neurogenic tumor, teratoma, and pericardial fat tissue, should be considered in the differential diagnosis [3]. …”