1. PATIENT PRESENTATION
A 30‐year‐old African female presented to the emergency department for worsening recurrent epigastric pain. She reported a history of peptic ulcer disease and reported noncompliance with proton pump inhibitor due to cost. An erect chest x‐ray (CXR) was obtained for evaluation, which revealed an incidental finding of a large left‐sided pleuropericardial cyst (benign congenital anomaly) as shown in the posteroranterior and lateral views. The images (Figures 1 and 2) demonstrate a large mass occupying the left hemithorax within mid and lower zones, measuring 12.5 × 8.3 cm. Lung markings can be seen through this lesion, and there is a loss of silhouette of the left heart border, suggesting it is in contact with the heart—no pleural effusion. The rest of the lungs are clear.
FIGURE 1.
A large mass occupying the left hemithorax within mid and lower zones, measuring 12.5 × 8.3 cm. Lung markings can be seen through this lesion, and there is a loss of silhouette of the left heart border, suggesting it is in contact with the heart—no pleural effusion. The rest of the lungs are clear
FIGURE 2.
Lateral chest X‐ray
2. DIAGNOSIS
2.1. Pleuropericardial cysts
Pleuropericardial cysts (PPCs) are rare mediastinal lesions, usually congenital, benign, and are rarely acquired or malignant.1 They are detected incidentally on routine chest X‐rays or post‐mortem.2 Although most PPCs are asymptomatic, patients may present with chest pain or dyspnea but can occasionally cause life‐threatening complications, such as pericardial tamponade.3, 4, 5
Asymptomatic cases are managed conservatively with a close follow‐up using non‐contrast computed tomography (CT), ultrasound, or magnetic resonance imaging (MRI). Surgical excision of the cyst has been considered the gold standard of management (especially in complicated cases) with excellent outcomes.2
Our patient was found to have H. pylori infection and began triple therapy. The patient was given an outpatient follow‐up for a CT scan of chest to further evaluate the cyst. However, the patient was lost to follow up.
Bin Hariz S, El Khalifa A, Alhmoudi A. Epigastric pain with incidental finding on a chest radiograph. JACEP Open. 2021;2:e12570. 10.1002/emp2.12570
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