Presentation
Incidental finding.
Patient Data
A well-defined polylobulated cystic lesion is seen in the right anterior cardiophrenic angle adjacent to the pericardium. It demonstrates fluid attenuation with no enhancement following intravenous contrast administration likely in keeping with a pericardial cyst.
A follow-up CT exam was performed a year later showing the same fluid collection extending along the right major fissure (best seen on the sagittal reformatted image).
The images illustrate the migration of the cyst from the right anterior cardiophrenic angle (upper image) to the right major fissure (lower image).
Case Discussion
Wandering pericardial cysts (a.k.a migrating pericardial cysts) are extremely rare, and only a few cases have been reported in the literature 1.
It refers to pedunculated pericardial cysts attached to the pericardial sac by a thin stalk which is not always readily visible on imaging. The stalk permits mobility of the cyst allowing it to be situated away from the pericardium altering its position on serial imaging for months to years 2.
Remarkably, and as in our case, pericardial cyst migration has only been reported with right-sided cysts probably due to the anatomical proximity of the right major fissure to the pericardium 2.
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