Case Report: From Neck to Chest, a Surgical Quest to Address Complex Pericardial Cysts and Compressive Threats

Introduction: Pericardial cysts are rare and often asymptomatic. Hence may exist without its existence being known. However, when they are large enough and/or when they coexist with other conditions that cause compressive symptoms such as goitres, they can pose significant challenges. We present a case report of a 61-year-old lady with multiple co-morbidities and recurrent multinodular goitre (MNG) post-total thyroidectomy who had an incidental finding of a pericardial cyst with concurrent tracheal stenosis. Discussion: CT thorax revealed a large pericardial cyst at the right costophrenic angle and abutting the right heart border. The presence of both the pericardial cyst and the multinodular goitre contributing to airway compression necessitated a careful surgical planning involving multidisciplinary teams including cardiothoracic surgery, anaesthesiology & intensive care as well as breast & endocrine surgical team. The patient underwent a right video-assisted thoracoscopic surgery (VATS) pericardial cyst excision following a successful thyroidectomy with intraoperative neurophysiological monitoring (IONM) to relieve the airway compression by the goitre. Conclusion: The case highlights the successful excision of a large pericardial cyst with co-existing MNG with airway compression that required technical precision as well as interdisciplinary collaboration.