Andersons pediatric cardiology 1530
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FIG.57.13 Chestradiographinanteroposteriorviewfromanadolescent
boywithabsentpericardium.Cardiomegalywithinconspicuousrightheart
borderisevident.Lungtissue(arrow)isinterposedinprominentspace
betweenaortaandmainpulmonaryartery.Theleftheartborderisstraight
andelongated(Snoopysign).
PericardialCysts
Congenitalpericardialcystsarerareandresultfromfailureoffetallacunaeto
coalescewiththepericardialcoelom.130Uncommonly,thesecystsmaybe
inflammatoryorposttraumatic.Inmostinstances,thepatientisasymptomatic
andcystsareincidentallydetectedonchestx-rayorCTscan.Rarely,infectionof
thecystorbronchialcompressionmaycausechestpainanddyspnea.131,132
Smallcystsmayevadedetectiononroutineechocardiography.Thepresenceof
echo-freespaceadjacenttotheheartonechocardiographyshouldraisesuspicion
ofpericardialcyst.MRIprovidesdiagnosticconfirmation.Notreatmentis
requiredforanasymptomaticpericardialcyst.Thosewithinfectionand
bronchialcompressionrequiresurgicalexcision.
Acknowledgments
IamindebtedtothelateDr.RajnishJuneja,ProfessorofCardiology,AllIndia
InstituteofMedicalSciences,NewDelhi,forprovidinginsightsinthe
managementofbacterialpericarditis.IamalsogratefultoDr.SandeepSingh,
ProfessorofCardiology,AllIndiaInstituteofMedicalSciences,NewDelhi,for
criticalreviewofthemanuscript.
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