Intrapericardial bronchogenic cyst::Assessment with magnetic resonance imaging and transesophageal echocardiography

ducing a sanginous fluid containing no organisms or A bronchogenic cyst, the most common type of intramalignant cells) and oral steroids. An echocardiothoracic foregut cyst, arises from an abnormality of gram later that year was reported to be normal with tracheobronchial tree budding. Lined by columnar the exception of mild mitral valve prolapse. respiratory epithelium, these cysts may arise from In the emergency room, physical examination was many locations including the pericarinal, paratraunremarkable except for mild respiratory distress. cheal, and intrapulmonary regions. Rarely, these Standard blood chemistries and cell counts were cysts are identified in unusual locations, making diwithin normal limits. A chest radiograph was obagnosis challenging. We present a case where a brontained and was negative. Blood gases demonstrated chogenic cyst is discovered within the pericardium mild hypoxemia (PO2 5 72.3) and the patient was of a middle-aged women presenting with chest pain, sent for ventilation/perfusion imaging. This study redyspnea on exertion, and shortness of breath. Imvealed a mismatched perfusion defect in the right aging, surgical intervention, and pathologic speciupper lobe, suspicious for acute pulmonary embomens provide a complete overview of this unusual lus. Heparin was begun, and subsequent pulmonary case. A review of the literature, including developangiography proved negative. mental characteristics, pathology, symptomatology, The patient remained stable until the day of transand radiologic features of bronchogenic cysts is also fer to Johns Hopkins when she developed upper exprovided. tremity, chest, and neck edema, and moderate cyano-