SHM Converge Scientific Abstract ePoster Gallery-A Benign Pericardial Cyst With Malignant Behavior: Progressive Enlargement and Compression Mimicking Acute Coronary Syndrome

A Benign Pericardial Cyst With Malignant Behavior: Progressive Enlargement and Compression Mimicking Acute Coronary Syndrome

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This case describes a 57-year-old man with recurrent chest pain, rising troponins, and ischemic ECG changes that repeatedly mimicked acute coronary syndrome. He had multiple cardiovascular risk factors, including heart failure with reduced ejection fraction, hypertension, diabetes, untreated sleep apnea, and methamphetamine use, and was initially managed as non-ST-elevation ACS.<br /><br />Despite symptoms and biomarker elevation, coronary angiography repeatedly showed patent epicardial coronary arteries. CT angiography and later cardiac MRI identified a progressively enlarging pericardial cyst adjacent to the lateral left ventricular wall. Over four years, the cyst grew from about 4.4 cm to 6.7 cm, with MRI measuring it at approximately 7.0 × 3.9 cm. The cyst was thought to cause intermittent extrinsic compression of the myocardium, possibly affecting the adjacent left circumflex coronary artery, explaining the recurrent ischemic-like episodes.<br /><br />The patient underwent CT-guided percutaneous aspiration of clear serous fluid. Infectious, inflammatory, and cytologic testing was negative, and chest pain resolved after drainage. He was discharged on guideline-directed medical therapy for heart failure.<br /><br />The main teaching point is that even “benign” pericardial cysts can become clinically important when they enlarge or are strategically located. In patients with recurrent ACS-like presentations, nonobstructive coronaries, and persistent regional ECG changes, clinicians should reassess for structural causes using multimodality imaging and review prior studies for progression. Early recognition can prevent repeated invasive testing and lead to targeted treatment.

Asset Subtitle

Chia-Hung Sze

Meta Tag

Author List Chia-Hung Sze, Heena Mansuri, Joel Fernandez, Padideh Daneii, Shrinand Shah

Category Clinical Vignettes

Concept Pericardial Cyst

Concept Cardiac Compression

Concept Acute Coronary Syndrome

Concept Cardiac Imaging

Concept Benign Lesion

Distinguished Non-Finalist

Presenter Organization Lakeland Regional Health

Presenting Author Chia-Hung Sze

Track Adult

Keywords

pericardial cyst

acute coronary syndrome mimic

ischemic ECG changes

elevated troponin

nonobstructive coronary arteries

cardiac MRI

CT angiography

myocardial compression

percutaneous aspiration

recurrent chest pain

Pericardial Cyst

Cardiac Compression

Acute Coronary Syndrome

Cardiac Imaging

Benign Lesion