CTICasesPericardial Cyst
[...]. Pericardial Cyst. CTICases. Published September 11, 2026. https://cticases.com/c/hbp9f
Imaging findings
The chest radiograph showed a convexity in the anterior cardiophrenic angle. Native mediastinal fat normally has a concave upper margin, and this margin was convex. The finding was subtle and varied across prior radiographs but was real. CT showed a low attenuation, very uniform, imperceptibly marginated lesion in that location, characteristic of a pericardial cyst.
Key takeaways
A convex rather than concave upper margin at the anterior cardiophrenic angle is the trigger to work through a short differential: a Morgagni hernia, in which the fat is abdominal rather than mediastinal and therefore produces that convexity, a pericardial cyst, and lymphadenopathy in the setting of lymphoma or abdominal malignancy. Pericardial cysts here are often pedunculated and can shift substantially with gravity, so position between an upright radiograph and a supine CT explains apparent movement. Pericardial lesions elsewhere in the mediastinum are more often diverticula, which communicate and can change size or empty entirely, whereas the cardiophrenic angle lesion behaves as a true cyst that moves but never disappears.
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