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He worked in the environmental department of the National Republican Guard&#44; and was thus frequently in contact with animals&#46; There was no relevant travel abroad&#44; consumption of potentially hazardous foods&#44; or alcohol or drug abuse&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Regarding family history&#44; his mother was diagnosed with systemic hypertension in her twenties and was being followed for suspected aortic dilatation and cardiac valve disease&#46; His father also had hypertension&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient was asymptomatic and underwent routine exams&#44; including an electrocardiogram which revealed nonspecific abnormalities due to which he was referred for a transthoracic echocardiogram &#40;TTE&#41;&#46; This showed an intracardiac cystic mass&#46; A transesophageal echocardiogram &#40;TEE&#41; and additional blood tests were performed&#46; The latter only revealed eosinophilia of 3&#46;1&#37;&#44; while the former confirmed the presence of a cystic mass with a diameter of 4&#46;5 cm located in the interventricular septum&#44; protruding into the left ventricular outflow tract and extending to 1 cm below the aortic valve&#44; with associated septal hypokinesia&#44; and without continuity with the cardiac chambers&#46; A bicuspid aortic valve with moderate aortic regurgitation and a dilated ascending aorta were also observed&#46; Magnetic resonance imaging &#40;MRI&#41; showed the mass to be hyperintense in T2&#44; revealed moderate aortic regurgitation and confirmed the other echocardiographic findings &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; The patient was asymptomatic&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">He was then referred for cardiac surgery evaluation&#44; and underwent a new TTE in our hospital&#44; which confirmed the previous findings&#46; The case was discussed and accepted for surgery&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The patient underwent surgery&#44; the cyst being excised through enucleation by blunt dissection with &#40;at times unsuccessful&#41; attempts to preserve the capsule &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A-C&#41; plus aortic valve replacement with a mechanical valve &#40;27 mm St&#46; Jude Medical Regent<span class="elsevierStyleSup">&#174;</span>&#41;&#46; The ascending proximal aorta and the aortic root &#40;noncoronary sinus&#41; were replaced with a 28 mm Gelseal<span class="elsevierStyleSup">&#174;</span> graft by a modified Bentall procedure&#46; There were no complications during surgery&#46; The postoperative echocardiogram showed that the inferior part of the septum was thin and dyskinetic&#44; but there were no other abnormalities&#46; The patient was discharged 10 days after surgery &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>D-E&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Pathological examination of the cyst revealed that macroscopically it was a cystic formation 4 cm in its largest diameter and microscopically a cyst with a sheath composed of a single cell layer&#44; positive for keratin and vimentin&#46; The wall was thin and fibrous with focal and scattered calcifications and in continuity with the adjacent myocardium&#46; The diagnosis was a simple mesothelial pericardial cyst &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>F-G&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Congenital pericardial cysts occur in 1&#47;100<span class="elsevierStyleHsp" style=""></span>000 individuals and account for 7&#37; of mediastinal masses&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Pericardial cysts are usually detected in middle-aged adults&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Pericardial cysts are commonly located in the left &#40;51-70&#37;&#41; and right &#40;28-38&#37;&#41; cardiophrenic angles and a small percentage are located in the upper mediastinum&#44; hilum or cardiac border&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In this case&#44; the cyst was diagnosed in the fourth decade of life&#46; To our knowledge&#44; this is the first reported case of a pericardial cyst with an intramyocardial location&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Congenital pericardial cysts arise when a portion of the pericardium pinches off during embryonic development&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Lambert proposed a new causal concept&#44; the &#8220;lacuna theory&#8221;&#44; suggesting that cysts derive from disconnected mesenchymal lacunae&#44; which later unite to form the pericardial cavity&#46; Failure of one of these lacunae to merge with the others would result in the formation of a congenital cyst&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Wessels and P&#233;rez-Pomares<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> draw attention to the transmural migration and differentiation pathways of epicardially derived cells&#44; which act as cardiac stem cells&#46; Such cellular behavior could explain unusual intracardiac&#44; including intramyocardial&#44; locations of pericardial cysts&#44; as in our patient&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The classic description of a pericardial cyst is a unilocular&#44; smooth-walled cyst with an outer layer of endothelial or mesothelial cells&#46; Their serous fluid-filled center and lack of solidity distinguishes them from other pericardial masses&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The majority of pericardial cysts are asymptomatic&#44; but they can cause symptoms of dyspnea&#44; thoracic pain&#44; and cough&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Pericardial cysts are usually incidental findings&#44; appearing as a round mass on chest radiography or as a homogeneous echolucent mass on TTE&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> TEE can be useful if TTE is insufficient to establish the diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> On MRI their contents are hyperintense on T2-weighted images and hypointense on T1-weighted images&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The diagnosis of pericardial cysts is not always straightforward since they may present in atypical locations&#46; Furthermore&#44; neither of the available non-invasive imaging modalities is sufficiently reliable to differentiate pericardial cysts from other pericardial masses with similar appearances but with different prognosis and treatments&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The differential diagnosis should take into consideration solid tumors&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> hydatid cysts and mesotheliomas&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">This patient denied any symptoms and the cyst was an incidental finding&#46; None of the imaging exams performed aided in establishing the correct diagnosis&#44; probably due to the extremely unlikely location&#44; although the imaging description corresponded largely to that of a pericardial cyst&#46; The main differential diagnosis considered before surgery was hydatid cyst&#44; due to the patient&#39;s occupational background&#44; local epidemiology and eosinophilia&#46; The latter could have been related to allergic rhinitis&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Rarely&#44; pericardial cysts can have a complicated course with rupture&#44; erosion into adjacent structures&#44; cardiac tamponade&#44; and even sudden death&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The management of pericardial cysts may be conservative or surgical&#44; or involve percutaneous aspiration&#46; Surgical resection is widely accepted as the treatment of choice when a patient has symptoms related to a mediastinal mass or if the diagnosis is uncertain&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Due to the patient&#39;s indication for surgical treatment for aortic ectasia and bicuspid aortic valve disease&#44; the cyst was resected concomitantly&#46; The suspicion of a hydatid cyst was an additional motive for excision&#44; due to the risk of rupture and consequent anaphylaxis&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In conclusion&#44; to the best of our knowledge this is probably the first description of an intramyocardial pericardial cyst&#46; The explanation for this unexpected location is uncertain&#44; despite the above-mentioned evidence and theories&#46; This case indicates the need to consider alternative diagnoses&#44; even if in an unlikely location&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Ethical disclosures</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Protection of human and animal subjects</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Confidentiality of data</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Right to privacy and informed consent</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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Case report
Simple mesothelial pericardial cyst in a rare location
Cisto pericárdico mesotelial simples numa localização rara
Sara Ranchordása,
Corresponding author
sranchordas@chlo.min-saude.pt

Corresponding author.
, Catarina Gomesb, Miguel Abecasisa, Rosa Gouveiac, João Abecasise, Luís R. Lopesb,d, Paula Fazendasb
a Cardiac Surgery Department, Santa Cruz Hospital, Carnaxide, Portugal
b Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
c Pathology Department, Santa Cruz Hospital, Carnaxide, Portugal
d CCUL, University of Lisbon, Lisbon, Portugal
e Cardiology Department, Santa Cruz Hospital, Carnaxide, Portugal
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Congenital pericardial cysts are rare and benign intrathoracic lesions&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a> The preferential location is in the cardiophrenic angles&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> but other unusual locations have been described&#46; We present a case of a pericardial cyst in a particularly uncommon location&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Case report</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 39-year-old man was referred for evaluation of an intracardiac mass&#46; His past medical history was irrelevant except for allergic rhinitis&#46; He worked in the environmental department of the National Republican Guard&#44; and was thus frequently in contact with animals&#46; There was no relevant travel abroad&#44; consumption of potentially hazardous foods&#44; or alcohol or drug abuse&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Regarding family history&#44; his mother was diagnosed with systemic hypertension in her twenties and was being followed for suspected aortic dilatation and cardiac valve disease&#46; His father also had hypertension&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient was asymptomatic and underwent routine exams&#44; including an electrocardiogram which revealed nonspecific abnormalities due to which he was referred for a transthoracic echocardiogram &#40;TTE&#41;&#46; This showed an intracardiac cystic mass&#46; A transesophageal echocardiogram &#40;TEE&#41; and additional blood tests were performed&#46; The latter only revealed eosinophilia of 3&#46;1&#37;&#44; while the former confirmed the presence of a cystic mass with a diameter of 4&#46;5 cm located in the interventricular septum&#44; protruding into the left ventricular outflow tract and extending to 1 cm below the aortic valve&#44; with associated septal hypokinesia&#44; and without continuity with the cardiac chambers&#46; A bicuspid aortic valve with moderate aortic regurgitation and a dilated ascending aorta were also observed&#46; Magnetic resonance imaging &#40;MRI&#41; showed the mass to be hyperintense in T2&#44; revealed moderate aortic regurgitation and confirmed the other echocardiographic findings &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; The patient was asymptomatic&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">He was then referred for cardiac surgery evaluation&#44; and underwent a new TTE in our hospital&#44; which confirmed the previous findings&#46; The case was discussed and accepted for surgery&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The patient underwent surgery&#44; the cyst being excised through enucleation by blunt dissection with &#40;at times unsuccessful&#41; attempts to preserve the capsule &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A-C&#41; plus aortic valve replacement with a mechanical valve &#40;27 mm St&#46; Jude Medical Regent<span class="elsevierStyleSup">&#174;</span>&#41;&#46; The ascending proximal aorta and the aortic root &#40;noncoronary sinus&#41; were replaced with a 28 mm Gelseal<span class="elsevierStyleSup">&#174;</span> graft by a modified Bentall procedure&#46; There were no complications during surgery&#46; The postoperative echocardiogram showed that the inferior part of the septum was thin and dyskinetic&#44; but there were no other abnormalities&#46; The patient was discharged 10 days after surgery &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>D-E&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Pathological examination of the cyst revealed that macroscopically it was a cystic formation 4 cm in its largest diameter and microscopically a cyst with a sheath composed of a single cell layer&#44; positive for keratin and vimentin&#46; The wall was thin and fibrous with focal and scattered calcifications and in continuity with the adjacent myocardium&#46; The diagnosis was a simple mesothelial pericardial cyst &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>F-G&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">Congenital pericardial cysts occur in 1&#47;100<span class="elsevierStyleHsp" style=""></span>000 individuals and account for 7&#37; of mediastinal masses&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Pericardial cysts are usually detected in middle-aged adults&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Pericardial cysts are commonly located in the left &#40;51-70&#37;&#41; and right &#40;28-38&#37;&#41; cardiophrenic angles and a small percentage are located in the upper mediastinum&#44; hilum or cardiac border&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">In this case&#44; the cyst was diagnosed in the fourth decade of life&#46; To our knowledge&#44; this is the first reported case of a pericardial cyst with an intramyocardial location&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Congenital pericardial cysts arise when a portion of the pericardium pinches off during embryonic development&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Lambert proposed a new causal concept&#44; the &#8220;lacuna theory&#8221;&#44; suggesting that cysts derive from disconnected mesenchymal lacunae&#44; which later unite to form the pericardial cavity&#46; Failure of one of these lacunae to merge with the others would result in the formation of a congenital cyst&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Wessels and P&#233;rez-Pomares<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> draw attention to the transmural migration and differentiation pathways of epicardially derived cells&#44; which act as cardiac stem cells&#46; Such cellular behavior could explain unusual intracardiac&#44; including intramyocardial&#44; locations of pericardial cysts&#44; as in our patient&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The classic description of a pericardial cyst is a unilocular&#44; smooth-walled cyst with an outer layer of endothelial or mesothelial cells&#46; Their serous fluid-filled center and lack of solidity distinguishes them from other pericardial masses&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The majority of pericardial cysts are asymptomatic&#44; but they can cause symptoms of dyspnea&#44; thoracic pain&#44; and cough&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Pericardial cysts are usually incidental findings&#44; appearing as a round mass on chest radiography or as a homogeneous echolucent mass on TTE&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> TEE can be useful if TTE is insufficient to establish the diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> On MRI their contents are hyperintense on T2-weighted images and hypointense on T1-weighted images&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The diagnosis of pericardial cysts is not always straightforward since they may present in atypical locations&#46; Furthermore&#44; neither of the available non-invasive imaging modalities is sufficiently reliable to differentiate pericardial cysts from other pericardial masses with similar appearances but with different prognosis and treatments&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The differential diagnosis should take into consideration solid tumors&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> hydatid cysts and mesotheliomas&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">This patient denied any symptoms and the cyst was an incidental finding&#46; None of the imaging exams performed aided in establishing the correct diagnosis&#44; probably due to the extremely unlikely location&#44; although the imaging description corresponded largely to that of a pericardial cyst&#46; The main differential diagnosis considered before surgery was hydatid cyst&#44; due to the patient&#39;s occupational background&#44; local epidemiology and eosinophilia&#46; The latter could have been related to allergic rhinitis&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Rarely&#44; pericardial cysts can have a complicated course with rupture&#44; erosion into adjacent structures&#44; cardiac tamponade&#44; and even sudden death&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">The management of pericardial cysts may be conservative or surgical&#44; or involve percutaneous aspiration&#46; Surgical resection is widely accepted as the treatment of choice when a patient has symptoms related to a mediastinal mass or if the diagnosis is uncertain&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Due to the patient&#39;s indication for surgical treatment for aortic ectasia and bicuspid aortic valve disease&#44; the cyst was resected concomitantly&#46; The suspicion of a hydatid cyst was an additional motive for excision&#44; due to the risk of rupture and consequent anaphylaxis&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In conclusion&#44; to the best of our knowledge this is probably the first description of an intramyocardial pericardial cyst&#46; The explanation for this unexpected location is uncertain&#44; despite the above-mentioned evidence and theories&#46; This case indicates the need to consider alternative diagnoses&#44; even if in an unlikely location&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Ethical disclosures</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Protection of human and animal subjects</span><p id="par0115" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Confidentiality of data</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Right to privacy and informed consent</span><p id="par0125" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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            0 => "Pericardial cyst"
            1 => "Echocardiography"
            2 => "Magnetic resonance imaging"
            3 => "Pathology"
          ]
        ]
      ]
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          "clase" => "keyword"
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          "palabras" => array:4 [
            0 => "Cisto peric&#225;rdico"
            1 => "Ecocardiograma"
            2 => "Resson&#226;ncia magn&#233;tica"
            3 => "Patologia"
          ]
        ]
      ]
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pericardial cysts are rare and generally benign intrathoracic lesions&#44; most frequently located in the cardiophrenic angles&#44; but other locations have been described&#46; We present a case of a pericardial cyst in a previously undescribed site&#46; Our patient presented with a cyst in the interventricular septum which was discovered as an incidental finding&#46; After surgical excision of the cyst&#44; it was described pathologically as a simple mesothelial pericardial cyst&#46; The explanation of this rare condition is uncertain&#44; but some hypotheses can be outlined&#46;</p></span>"
      ]
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Os cistos peric&#225;rdicos s&#227;o les&#245;es intrator&#225;cicas raras e geralmente benignas&#44; mais frequentemente localizadas nos &#226;ngulos cardiofr&#233;nicos&#44; no entanto&#44; outras localiza&#231;&#245;es t&#234;m sido descritas&#46; Apresentamos o caso de um cisto peric&#225;rdico num local n&#227;o descrito previamente&#46; O nosso doente apresentou-se com um cisto no septo interventricular que foi detetado como achado incidental&#46; Ap&#243;s a excis&#227;o cir&#250;rgica do cisto&#44; este foi descrito anatomopatologicamente como um cisto peric&#225;rdico mesotelial simples&#46; A explica&#231;&#227;o para esta localiza&#231;&#227;o incomum &#233; incerta&#44; mas algumas hip&#243;teses podem ser delineadas&#46;</p></span>"
      ]
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Imaging of the cyst before surgery&#46; &#40;A-C&#41;&#58; Magnetic resonance imaging showing the cyst with T2-weighted hyperintense signal&#59; &#40;D and E&#41;&#58; transthoracic echocardiogram showing the location of the cyst in the interventricular septum and anechogenic appearance&#46;</p>"
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          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">&#40;A-C&#41;&#58; Images captured during surgical resection of the cyst&#46; &#40;A&#41;&#58; Cyst causing bulging of the interventricular septum and protruding into the left ventricular outflow tract&#59; &#40;B&#41;&#58; intramyocardial location of the cyst&#59; &#40;C&#41;&#58; cyst rupture and flow of clear fluid&#59; &#40;D and E&#41;&#58; transthoracic echocardiogram after surgery showing a thin interventricular septum and delineation of the previous location of the cyst&#59; &#40;F and G&#41;&#58; microscopic aspects of the cyst&#58; &#40;F&#41;&#58; cyst wall&#44; H &#38; E stain &#215;100&#59; &#40;G&#41;&#58; cytokeratin 5&#47;6 &#215;400 &#40;left&#41; and vimentin &#215;400 &#40;right&#41;&#58; keratin and vimentin co-expression by the cells of the internal layer of the cyst&#46; RE&#58; internal cell layer of the cyst&#59; F&#58; fibrosis&#59; M&#58; myocardium&#46;</p>"
        ]
      ]
    ]
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "A&#46; Raja"
                            1 => "J&#46;R&#46; Walker"
                            2 => "M&#46; Sud"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
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                      "Revista" => array:5 [
                        "tituloSerie" => "J Med Case Rep"
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                        "link" => array:1 [
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                          "etal" => false
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                            0 => "R&#46;H&#46; De Gouveia"
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        "identificador" => "xack276342"
        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0135" class="elsevierStylePara elsevierViewall">The authors wish to thank Carlos Aguiar&#44; MD&#44; for helping in the revision of the manuscript&#46;</p>"
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ISSN: 21742049
Original language: English
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Revista Portuguesa de Cardiologia (English edition)
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