Exertional Near-Syncope: Pericardial Cyst as a Cause of Left Ventricular Outflow Obstruction

CASE PRESENTATION: A 41-year-old otherwise healthy male presented to the emergency department with recurrent exertional near-syncope. He was eventually found to have a large pericardial cyst causing an outflow obstruction. After resection of the cyst by cardiothoracic surgery, he had an uneventful hospital course and was discharged seven days later with no recurrent syncopal episodes. DISCUSSION: We describe an otherwise healthy patient who exhibited symptomatic left ventricular outflow obstruction from a pericardial cyst. These cysts are usually benign and asymptomatic, although they can progress to cause significant morbidity or mortality. Surveillance is recommended if no hemodynamic compromise is present. Patients who are symptomatic or have hemodynamic compromise may undergo needle aspiration or thoracoscopy with resection.