Pericardial cysts of the mediastinum

Pericardial cysts are an uncommon benign disease. Their treatment, in the p ast, was based on excision by thoracotomy or, in selected cases, on percuta neous aspiration. The progress of video-assisted thoracoscopy gave new poss ibilities, but most surgeons still consider the thoracotomic approach as th e treatment of choice. The aim of this study is to report our experience an d to discuss the role of different therapeutic procedures in the management of pericardial cysts. Between 1970 and 1996, 24 patients with pericardial cysts were treated at the first Department of Surgery of the University of Rome La Sapienza. Of 24 cysts, six were located in the right cardiophrenic angle, three in the left cardiophrenic angle, two In the subcarenal areas, one in the paracardiac area and one on the posterior mediastinum. Ten patie nts were asymptomatic. Diagnosis was performed preoperatively only in patie nts with cysts typically located in the cardiophrenic angle. Twenty-three p atients were surgically treated by a standard posterolateral thoracotomy or limited thoracotomy with sparing of muscles. One patient underwent CT- gui ded transparietal fine-needle aspiration There were no cases of operative m ortality. Morbidity was 12.5% and consisted of retained secretions, moderat e hypoxemia and partial atelectasis. All patients were submitted to a long- term follow-up and no cyst recurrences were found. We conclude that excisio n via thoracotomy is an optimal treatment for pericardial cysts. Limited th oracotomy with sparing muscles offers a good cosmetic result and a rapid fu nctional respiratory recovery. Percutaneous cyst aspiration may be, in sele cted patients, an attractive alternative to surgery.