PMC6051322_01
(a) Chest X-ray immediately following pacemaker insertion procedure showing normal right atrial contour with no opacification in the right lung field. (b) Chest X-ray showing opacity in the right middle lobe on admission. (c) Computed tomography showed a thickened pericardium and pericardial effusion (blue arrow), pericardial cyst (blue stars), and the pacemaker electrode lining the epicardial surface of the right ventricle (yellow arrow).
CRIC2018-2527413.001.jpg
PMC6051322_01_CRIC2018-2527413.001.jpg
fig1
Chest film showed a round opacity with smooth borders in the midright lung field:a major change compared to prior films (Figures 1(a) and 1(b)). C-reactive protein (CRP) of 6.25 mg/dL. Computed tomography (CT) of the chest revealed thickened pericardium with pericardial effusion (Figure 1(c), blue arrow), a 6.8 x 6.2 cm thick-walled pericardial cystic mass (blue stars) adjacent to the tip of atrial pacemaker lead suspected to be extracardiac (yellow arrow).
Intraoperative images during resection of the pericardial surgery and the resected pericardial cyst.
CRIC2018-2527413.002.jpg
PMC6051322_01_CRIC2018-2527413.002.jpg
fig2
Macroscopically, the cyst wall was thickened with intense fibrosis, areas of hemorrhages, and active inflammation (Figure 2).
Microscopic description of the inflamed pericardial pseudocyst. (a) The inner cyst wall was devoid of the epithelial lining with ulceration and hemorrhage (blue arrows) on a background of chronic inflammation (yellow stars). (b) The outer cyst surface showed fibrinous exudate (yellow arrows).
CRIC2018-2527413.003.jpg
PMC6051322_01_CRIC2018-2527413.003.jpg
fig3
Histological examination revealed a lack of the epithelial lining over the inner surface, scattered ulcerations, fibrin depositions, hemorrhages, hemosiderin-laden macrophages, and chronic inflammation (Figure 3).