Pericardial cysts and diverticula are indistinguishable both arising from the parietal pericardium and drooping down under the weight over their contents. The contents can be confirmed on CT as fluid density although a small subset may be hyperdense. Careful technique is required to exclude erroneous densitometry due to beam hardening from intracardiac contrast. MRI, including T1 fat suppressed pre and post contrast imaging can confirm the cystic nature and absence of enhancement. Echocardiography can also be helpful but may not evaluate the lesion entirety. These lesions are usually asymptomatic although 1/3 may have a variety of non-specific symptoms. They occur more frequently in men and usually on the right side (80%). Their appearance can be vary variable on plain films depending on position and inspiration. They may appear as variable masses and cause confusion with right atrial dilatation. The key differential consideration on chest radiographs is that of a thymoma which can also extend in a mass like fashion along the right cardiac border as inferior as this. Occasionally thymomas can be cystic but usually the contents are more heterogeneous and there is a residual rim of enhancement.
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