Pericardial Mass as a Rare Cause of Unstable Angina in a Young Veteran

Abstract

CLINICAL CONDITION: A 35-year-old healthy male veteran presented with angina, shortness of breath with exertion, and near-fainting episodes. A transthoracic echocardiogram showed a septated cyst compressing the left ventricle. Cardiac magnetic resonance imaging and computed tomography angiography confirmed the presence of a pericardial cyst measuring 7.9 × 4.4 × 4.1 cm, located just 2 mm from the left anterior descending artery. KEY QUESTIONS: 1) Was the pericardial cyst the cause of his symptoms? 2) Does its location affect the left anterior descending artery? 3) Is diastolic collapse of the left ventricle related to the symptoms? OUTCOME: The veteran underwent a robot-assisted excision of the pericardial cyst, which was completed without complications, leading to the complete resolution of his symptoms. TAKE-HOME MESSAGES: Pericardial cysts can compress surrounding structures, causing systolic dysfunction and angina symptoms. Treatment should involve a multidisciplinary team including specialists in cardiology, thoracic surgery, and radiology.