Pericardial Cyst

What is a pericardial cyst?

A pericardial cyst is a fluid-filled growth in the thin sac (pericardium) that surrounds your heart. Usually, a pericardial cyst is congenital, meaning it’s something you’re born with.

Pericardial cysts are usually about 3 to 5 centimeters in diameter, but some can be larger. They’re round or oval in shape and have thin walls. Pericardial cysts are usually filled with clear fluid. That’s why in the 1940s, surgeons started calling them “spring water cysts.” They most often appear on the right side of your heart.

A pericardial cyst isn’t cancerous and often doesn’t cause symptoms. However, it can sometimes lead to symptoms and complications if it presses on your heart or lungs.

How serious is a pericardial cyst?

A pericardial cyst usually doesn’t cause serious problems. Rarely, it leads to complications including:

• Arrhythmia.
• Cardiac tamponade.
• Constrictive pericarditis.
• Heart failure.
• Fainting (syncope).
• Pneumonia.
• Right ventricular outflow tract obstruction.
• Sudden cardiac death.
• Superior vena cava syndrome (SVCS).

Who do pericardial cysts affect?

Pericardial cysts can affect people of all ages. They’ve been diagnosed in adults as old as 102. Sometimes, they’re diagnosed in fetuses during prenatal testing. Most people are in their 20s, 30s or 40s when they’re diagnosed.

They’re slightly more common among women and people designated female at birth compared with men and people designated male at birth.

How common is this condition?

Pericardial cysts affect about 1 in 100,000 people.

What are the symptoms of a pericardial cyst?

About 3 out of 4 people who have pericardial cysts feel no symptoms. If the cyst presses on your heart or lungs, you may have symptoms that include:

• Chest pain that may spread through your upper body.
• Cough.
• Respiratory infections that keep coming back.
• Shortness of breath (dyspnea).

How do you get a pericardial cyst?

A pericardial cyst is usually congenital (you’re born with it). It’s caused by a weakness in your pericardium that happens during development in the womb.

Less common causes of pericardial cysts include:

• Inflammation from pericarditis.
• Trauma to your chest.

How is a pericardial cyst diagnosed?

Providers usually find pericardial cysts when running tests (like chest X-rays) for other reasons. So, pericardial cysts are often what providers call an “incidental finding.”

Once your provider notices the growth, they’ll run other tests to confirm it’s a pericardial cyst. Your provider will rule out other diagnoses like:

• Aneurysm in your ventricle (lower heart chamber).
• Hernia in your diaphragm (Morgagni hernia).
• Other types of cysts.
• Tumor in your diaphragm.

What tests diagnose this condition?

Providers use the following tests to diagnose and manage pericardial cysts:

• Cardiac CT scan: To diagnose the cyst and evaluate your pericardium.
• Cardiac MRI: To check if the cyst is pressing on your heart or other structures.
• Echocardiography: To monitor the cyst over time and guide aspiration (draining of the cyst) if needed.

How do you treat pericardial cysts?

In most cases, treatment for pericardial cysts is conservative. Your provider will keep an eye on your cyst by running a transthoracic echocardiogram every couple of years. If it doesn’t get bigger and you don’t have symptoms, your provider will keep monitoring it but you won’t need any treatment.

However, some pericardial cysts need treatment through a minimally invasive procedure or surgery. Your provider may recommend draining or removal of your pericardial cyst if:

• You start feeling symptoms.
• The cyst gets bigger.

Minimally invasive procedures to drain the cyst include:

• Ethanol sclerosis: Injects ethanol into the cyst and then drains the cyst.
• Percutaneous aspiration: Uses a needle puncture to drain fluid from the cyst.

If you need surgery, your provider will use one of the following methods:

• Laparoscopic surgery: Tiny keyhole cuts.
• Median Sternotomy: Incision down the middle of your chest.
• Thoracotomy: Incision between your ribs.
• Video-assisted thoracic surgery (VATS): Small incision between your ribs.

Your provider will discuss the treatment options with you and determine the best method for your specific situation.

The goal of pericardial cyst treatment is to prevent serious complications from the cyst pressing on your heart or lungs.

How can I prevent pericardial cysts?

Since pericardial cysts are usually congenital, you can’t prevent them.

If you have a history of pericarditis, talk with your provider about your risk of developing a pericardial cyst.

Is a pericardial cyst dangerous?

Most of the time, pericardial cysts aren’t dangerous. They can become dangerous if they put pressure on your heart, lungs or other nearby structures. If you have a pericardial cyst, your provider will monitor it and provide treatment if needed.

What can I expect if I have this condition?

Most people with pericardial cysts have a good outlook. However, if you have symptoms or your cyst is growing, you may need treatment to prevent complications. Talk with your provider about your prognosis and your risk for complications.

When should I see my healthcare provider?

Visit your provider for annual checkups, and follow your provider’s guidance for follow-ups. Most people don’t know they have a pericardial cyst until an imaging test accidentally discovers it. So, it’s important to keep all your medical appointments and screenings. This gives you a better chance of catching a pericardial cyst early before it causes any problems.

If your provider aspirated (drained) your pericardial cyst, be sure to keep all your follow-ups. You have about a 30% chance of the cyst coming back. So, your provider will need to monitor you to check for a recurrence.

Call 9-1-1 or your local emergency number immediately if you have symptoms of sudden cardiac tamponade. These include:

• Changed mental state (feeling confused or agitated).
• Feeling dizzy or fainting.
• Sharp pain in your chest that may extend to your belly, back, neck, arm or shoulder.
• Rapid breathing.
• Rapid pulse.
• Skin color changes (pale, gray, or blue).
• Trouble breathing.

A note from Cleveland Clinic

Pericardial cysts often cause no symptoms and don’t lead to serious complications. But if your cyst is causing you symptoms, rest assured there are several treatment options available. Talk with your provider about the best treatment method for you and what you can expect for recovery.