Massive pericardial effusion and multiple pericardial masses due to an anterior mediastinal teratoma rupturing in pericardial sac

A 25 -year-old Egyptian man presented to our unit for the evaluation of a large pericardial effusion. At 1 month before presentation he suffered from daily bouts of fever. Chest x-ray revealed cardiomegaly, echocardiography showed large pericardial effusion and multiple pericardial masses. Needle pericardiocentesis revealed a bloody exudate with no malignant cells. Chest CT showed a well-circumscribed anterior mediastinal cystic mass with a central fat component and foci of calcification. MRI of the chest similarly showed no intracardiac extension. A cystic mass 7×9 cm was removed via a median sternotomy with uneventful postoperative course. Pathological evaluation revealed a benign cystic teratoma and a thymic cyst. Most cystic teratomas are accidentally discovered, large ones can cause symptoms through the compression of mediastinal structures or rupture in pericardial sac.