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Pericardial cysts are rare, benign, fluid-filled sacs that develop inside or around the pericardium, the sac that surrounds the heart. Most are congenital (present at birth) because of abnormal development of the pericardial lining. They are usually located next to the right heart and are often discovered inadvertently on chest imaging done for other reasons. Many times they grow slowly and stay tiny, and so many patients go asymptomatic.

When symptoms are present, they may include chest pain, a persistent cough, shortness of breath, palpitations, or a feeling of chest pressure due to compression of the surrounding structures. Diagnosis is usually by chest x-ray, echocardiography, computed tomography (CT), or magnetic resonance imaging (MRI) to exclude any chest pathology and determine the size, location, and features of the cyst.

The treatment depends upon the symptoms of the patient and the behavior of the cyst. Generally small asymptomatic cysts are tracked with merely occasional imaging to make sure there are no changes. If cysts are large or symptomatic, especially when they are causing compression or difficulties, they may need to be surgically removed or aspirated with a needle. Prognosis is generally good since most pericardial cysts are benign and stable. Regular follow-up will enable timely control of development, symptoms, or unusual sequelae throughout time.