Pericardial cyst with intracystic hemorrhage. A case report and review of the literature

Pericardial cysts are rare benign intrathoracic lesions, more often located in the right rather than in the left cardiophrenic angle. At echocardiography, they appear as echolucent unilocular structures, which are in contact with the pericardium. They contain a clear water-like fluid and, thus, are referred to as "spring water cysts". They are usually discovered incidentally in asymptomatic patients. Sometimes they can cause symptoms (dyspnea, chest pain, dysphagia, cough), depending on their dimensions and location, or severe complications such as cardiac tamponade. Asymptomatic cases are managed conservatively with a close follow-up, being surgical excision recommended only in symptomatic patients. Actually, the treatment options include excision via thoracotomy, video-assisted thoracoscopic surgery, and percutaneous echo-guided aspiration. We describe the case of a patient for whom the echocardiographic follow-up allowed to disclose intracystic hemorrhage, leading to surgical treatment before the patient became symptomatic.