Pericardial Cyst Masquerading as Constrictive Pericarditis

Background: Constrictive pericarditis is a challenging diagnosis to make because it can mimic heart failure, restrictive myocardial diseases, and massive pericardial effusion. Here we report an unusual case of pericardial cyst masquerading as constrictive pericarditis. Case summary: We present a case of a young gentleman, presenting with progressive shortness of breath, abdominal ascites and signs of right sided heart failure, imaging study with Transthoracic Echo and chest CT scan showed an unusual loculated extracardiac collection compressing on the right ventricle and right atrium, with pericardial wall calcification suggesting chronic pericarditis. Cardiac magnetic resonance (CMR) confirmed a pericardial origin of the mass. Surgical intervention was done as the pericardial cyst was large and causing pressure symptoms leading to quick symptomatic relief and recovery. Conclusion: Pericardial cysts are a rare encounter in clinical practice, which makes their management a clinical challenge. Further research is required to establish a comprehensive approach to managing congenital pericardial cysts.