A Patient with Left Cardiophrenic Angle Mass Presenting with Intermittent Chest Symptoms

Abstract

A 42-year-old male shopkeeper presented in the out-patient department (OPD), with intermittent cough for the last six months along with occasional compressive symptoms at the centre of chest and mild dyspnea on exertion. Detailed cardiological history was not contributory. Chest on auscultation showed diminished air entry in the left infra-scapular region with occasional crepitations; the right side of the chest and other systemic examinations were within normal limits. Chest X-ray postero-anterior (PA) view revealed a lobular opacity in the left cardio-phrenic angle. Routine blood investigations and 12-lead electrocardiography (ECG) revealed no abnormality. Two-dimensional echocardiography revealed a large well defined mass having echo-free space measuring 9.0 × 5.6 cm, resting on the postero-lateral side of the left ventricle (LV) without any connection to ventricular cavity. Later contrast enhanced computed tomography (CECT) scan of the chest confirmed a large well circumscribed cystic lesion measuring 9.8 cm (antero-posterior) × 6.4 cm (supero-inferior) × 5.5 cm (transverse) in the left lower hemi-thorax, abutting the lateral aspect of the pericardial cavity, not separable from it and indenting the lateral wall of the LV. It had thin barely perceptible wall, homogeneous fluid attenuation content, without any foci of calcification, contrast enhancement, or internal septa. All imaging studies suggested a large congenital benign pericardial cyst arising from the left cardiac border. In view of this large pericardial cyst causing local compressive symptoms, cardio-vascular surgical opinion was taken and they suggested for surgical excision of the cyst. Surgical procedure was uneventful with postero-lateral thoracotomy in the 6th intercostal space and complete excision of the cyst measuring 9 cm × 7 cm × 5 cm, containing clear straw-coloured fluid inside. The patient recovered favorably in post-operative period without any resurgence of compressive symptoms or cough.

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