Conditions ExpertDr.

Otis BrawleyChief Medical Officer, American Cancer Society

Expert answer
The pericardium is a bag-like structure that surrounds the heart. It is normally a smooth, thin tissue. A pericardial cyst is a small fluid-filled mass that is part of the pericardium. It is sometimes called "spring water cysts of the pericardium" because it is filled with clear liquid. Pericardial cysts are a very rare entity and it's even rarer that they cause symptoms. They are usually diagnosed as an incidental finding on a chest X-ray or CT scan done for some other reason. The pericardium and heart are located in the mediastinum. This is the space in the chest between the lungs. Also in the mediastinum are the esophagus and a gland called the thymus. Things that can appear in this area and be confused with pericardial cysts are a few cancers, especially lymphomas (or cancers of the lymph nodes), and some rare parasitic infections such as echinococcus. The distinction is usually confirmed with CT or MRI looking for the characteristic water density in the cyst. These tests are interpreted by radiologists. It is generally not difficult for an expert radiologist to make this determination if a mass is suspected to be a pericardial cyst. The approach to a pericardial cyst is to verify that it is truly a pericardial cyst and monitor it if it is asymptomatic. In the rare instance in which the cyst causes a problem, it is because it has become so large that it is pressing on the heart or the large blood vessels leading to or from the heart and obstructing blood flow. A symptomatic cyst can usually be treated by a needle passed through the chest wall with ultrasound or CT guidance to drain it. Ethanol is sometimes injected in the drained space to keep the cyst from recurring.