Background: The pericardial cysts are benign "tumors" of the antero-inferior mediastinum, most often asymptomatic, which diagnosis is radiologic and incidental. When cysts are symptomatic and/or diagnosis is difficult, any resort to invasive diagnostic examinations and surgical ablation is suitable.
Methods: From January 1993 to January 1994 five patients with pericardial cyst have been treated. Three patients were symptomatic: two suffering from cardiac arrhythmia and one had cough with dyspnea. In three cases the lesion had a typical location and typical radiological patterns, and diagnosis was made by chest X-ray, confirmed by computed tomography (CT). In one case chest X-ray and CT didn't allow a sure diagnosis (differential diagnosis with Morgagni's diaphragmatic hernia), and in another case all examinations suggested a relapsing pleural effusion.
Results: All patients underwent ablation of the cyst by VATS; no complications were observed and patients left the hospital, on average, after 2 days (range 1-3).
Conclusions: VATS, thanks to its low invasiveness, may be considered the method of choice for the diagnosis of atypical lesions and/or treatment of symptomatic cysts.