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1
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Raj V, Ahuja A, Gupta M, Chaudhry D, Singh PK. An uncommon cause of acute hypercapnic respiratory failure managed with endoscopic ultrasound. Lung India 2025; 42:151-154. [PMID: 40013636 PMCID: PMC11952737 DOI: 10.4103/lungindia.lungindia_423_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2024] [Revised: 12/11/2024] [Accepted: 12/23/2024] [Indexed: 02/28/2025] Open
Abstract
ABSTRACT Mediastinal cysts can occasionally cause severe respiratory symptoms. A 60-year-old female smoker presented with acute hypercapnic respiratory failure. Imaging revealed a posterior mediastinal cyst compressing the trachea. Bronchoscopic ultrasound-guided fine needle aspiration (EUS-B FNA) provided both diagnostic clarity and symptomatic relief. This case underscores the importance of considering mediastinal cysts in differential diagnoses of acute respiratory distress and demonstrates the efficacy of EUS-B FNA for both diagnosis and immediate therapeutic intervention.
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Affiliation(s)
- Vishal Raj
- Department of Pulmonary and Critical Care Medicine, Pt B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Aman Ahuja
- Department of Pulmonary and Critical Care Medicine, Pt B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Monika Gupta
- Department of Pathology, Pt B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, Pt B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Pawan Kumar Singh
- Department of Pulmonary and Critical Care Medicine, Pt B.D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
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Alomar K, Alrahil A, Omar W, Rastanawi A, Alshaikh N. Complete surgical resection of a thymic cyst located in the middle mediastinum with extension into the carina through a neck incision: A case report study. Int J Surg Case Rep 2025; 126:110696. [PMID: 39653002 PMCID: PMC11739921 DOI: 10.1016/j.ijscr.2024.110696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Revised: 11/23/2024] [Accepted: 11/28/2024] [Indexed: 01/15/2025] Open
Abstract
INTRODUCTION AND SIGNIFICANCE Thymic cysts are rare, located in the middle mediastinum, and are often asymptomatic and discovered incidentally. When they are symptomatic, the symptoms are often due to the effect of the mass, and complete surgical excision is preferred to avoid the risk of complications following their persistence. CASE PRESENTATION We present a case of a patient who had recurrent dyspnea and was later diagnosed with a cystic formation in the middle mediastinum by radiological investigations and successfully treated through a neck incision and completely resected. CLINICAL DISCUSSION Many physicians fail to include these cysts in the differential diagnosis of cystic lesions in the middle mediastinum, thus missing the opportunity to successfully manage these benign formations. CONCLUSION The neck incision is considered suitable and has less surgical trauma and less injury than the previously used transthoracic surgical approaches and therefore may be used in the future for the resection of middle mediastinum lesions in general.
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Affiliation(s)
| | - Ali Alrahil
- Department of Thoracic Surgery, Damascus Hospital, Damascus, Syria.
| | - Walat Omar
- Thoracic Surgeon-Department of Thoracic Surgery, Damascus Hospital, Damascus, Syria
| | | | - Naser Alshaikh
- Professor in Thoracic Surgery, Damascus Hospital, Damascus, Syria
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3
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Evison M, Robinson SD, Sharman A, Datta S, Rammohan K, Duerden R, Montero-Fernandez MA, Gilligan D. Making an accurate diagnosis of anterior mediastinal lesions: a proposal for a new diagnostic algorithm from the BTOG Thymic Malignancies Special Interest Group. Clin Radiol 2024; 79:404-412. [PMID: 38565483 DOI: 10.1016/j.crad.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/01/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
Due to the rising demand in cross-sectional thoracic imaging, anterior mediastinal lesions are being identified with increasing frequency. Following iterative and multidisciplinary discussions, the BTOG Thymic Malignancies Special Interest Group have developed an algorithm to standardise the diagnostic approach for these relatively uncommon but important conditions which span from benign (thymic remnant, thymic hyperplasia and thymic cysts) to suspected localised thymomas to suspected more aggressive malignancy (thymic carcinoma, lymphoma and germ cell tumours). For each condition, we provide a brief description, an overview of the key radiological findings and a description of the proposed algorithm including the rationale behind the recommendations. We also highlight the role of magnetic resonance (MR) imaging for the characterisation of anterior mediastinal masses in specific indications when the necessary local resources and expertise exist. In addition, we hope this provides the rationale for service development in MR of the anterior mediastinum where current resource and expertise requires development. Through this standardised pathway, we hope to drive improvements in patient care by rationalising surveillance schedules, avoiding unnecessary resections of benign entities with their associated morbidity and optimising the diagnostic work-up prior to the appropriate treatment of anterior mediastinal malignancies.
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Affiliation(s)
- M Evison
- Lung Cancer & Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Manchester Academic Health Science Centre (MAHSC), Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK.
| | - S D Robinson
- Sussex Cancer Centre, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK; Department of Biochemistry and Biomedicine, School of Life Sciences, University of Sussex, Falmer, Brighton, UK.
| | - A Sharman
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - S Datta
- Department of Radiology, Royal Alexandra Hospital, NHS Glasgow and Clyde, Glasgow, UK
| | - K Rammohan
- Lung Cancer & Thoracic Surgery Directorate, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - R Duerden
- Department of Radiology, Stepping Hill Hospital, Stockport NHS Foundation Trust, Stockport, UK
| | - M A Montero-Fernandez
- Department of Histopathology, Royal Liverpool University Hospital, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - D Gilligan
- Department of Oncology, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Liao Z, Wang H, An J, Dong J, Long X. A 49-Year-Old Man With Fever and Dyspnea After Endobronchial Ultrasound-Guided Transbronchial Fine Needle Aspiration Biopsy. Chest 2024; 165:e65-e69. [PMID: 38461020 DOI: 10.1016/j.chest.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/03/2023] [Accepted: 08/11/2023] [Indexed: 03/11/2024] Open
Abstract
CASE PRESENTATION A 49-year-old man, a farmer, had been experiencing coughing, phlegm, and difficulty breathing for 2 months. He underwent a CT scan at a local hospital that showed a mediastinal mass. Bronchoscopy showed no obstruction in the tracheal lumen, and an endobronchial ultrasound-guided transbronchial fine needle aspiration (EBUS-TBNA) biopsy was performed on the mediastinal mass. The cytologic smear of the mediastinal mass showed a few atypical epithelial cells; the possibility of a tumor could not be ruled out. The patient visited our thoracic surgery outpatient department; based on the advice of the thoracic surgeon, the patient underwent another endobronchial ultrasound-guided transbronchial fine needle aspiration biopsy of the mediastinal mass 4 days before this admission. The patient went home and waited for the results. Two days later, the patient experienced a fever and palpitations accompanied by chills, yellow phlegm, and orthopnea. The patient visited our ED, underwent tracheal intubation, and was admitted to our ICU. The patient had had occasional coughing and phlegm for the past 10 years, which were not taken seriously or investigated. The patient does not smoke or drink alcohol, and there is no history of cancer in the family.
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Affiliation(s)
- Zenglin Liao
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China.
| | - Hao Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Jing An
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Jiajia Dong
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaoyu Long
- Department of Pathology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
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Weissferdt A. Non-Neoplastic Thoracic Cysts: A Clinicopathologic Study of 136 Cases. Am J Surg Pathol 2023; 47:1349-1363. [PMID: 37642507 DOI: 10.1097/pas.0000000000002115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Benign cysts of the thoracic cavity represent a group of rare lesions, the spectrum of which is expanding. Most of these are congenital in nature, secondary to abnormal development during embryogenesis while a smaller subset represents acquired lesions. We retrospectively reviewed the clinicopathologic features of 136 patients with thoracic cysts that were treated in our institution over a span of 20 years. The patients were 85 female and 51 male patients with an average age of 51 years. Eighty-four of the patients were asymptomatic (62%), the remainder mainly presented with chest pain, shortness of breath, or cough. Surgical resection was performed in 123 patients while 12 patients were treated with aspiration only and 1 underwent core biopsy. The cyst size ranged from 0.5 to 14.8 cm (mean, 4.4 cm); histologically, the lesions included 50 thymic cysts (28 multilocular; 22 unilocular), 37 bronchogenic cysts, 23 pleuropericardial cysts, 12 unclassified cysts, 6 Müllerian cysts, 5 enteric cysts, and 3 parathyroid cysts. Clinical follow-up revealed that 97 patients were alive and well 4 months to 37 years after initial diagnosis; 25 patients were lost to follow-up and 14 patients died of unrelated causes. The current study is one of the largest studies on the subject with emphasis on clinicopathologic characteristics. This series has a higher incidence of thymic cysts compared with prior publications and covers a wider spectrum of different histologic types than previously reported.
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Affiliation(s)
- Annikka Weissferdt
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Ma TT, Chen G, Wang D, Xu H, Zhang JG. Clinical and imaging characteristics of patients with bronchogenic cysts: a single-center retrospective analysis. BMC Med Imaging 2023; 23:128. [PMID: 37710169 PMCID: PMC10503098 DOI: 10.1186/s12880-023-01042-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 06/05/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Bronchogenic cysts (BCs) are rare and usually asymptomatic malformations detected during imaging examinations. We aimed to investigate the clinical and imaging characteristics of patients with BCs. METHODS We retrospectively evaluated patients who received surgery to remove their BCs from January 2015 to January 2019. Their baseline characteristics, clinical information, and imaging results were reviewed. RESULTS Our study included 129 patients, with 57 males and 72 females and a mean age of 42.7 years old. The most common location for BCs was the mediastinum (67 patients, 51.9%). Fewer than half of the patients (53 patients, 41.1%) reported clinical symptoms, with chest pain being the most common (16 patients, 30.2%). Neck BCs were more frequently observed in young patients (P = 0.002) and were more often associated with thyroid cancer (P = 0.007). A computed tomography scan was the most commonly used method to diagnose BCs in the lung and mediastinum, whereas ultrasound was the most commonly used diagnostic method for neck BCs. The characteristic images were well-defined, thin-wall cystic lesions in varying densities. A few lesions showed small, calcified spots along the rim or cavities. CONCLUSIONS Although most BCs were found in the mediastinum, their locations could vary in different sex and age groups. Particular attention should be paid to young patients with BCs in the neck to rule out thyroid cancer.
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Affiliation(s)
- Tan-Tan Ma
- Department of Gastroenterology, The First Hospital of Jilin University, 71 Xinmin Street Changchun, Jilin, 130021, China
| | - Geng Chen
- Department of Gastroenterology, The First Hospital of Jilin University, 71 Xinmin Street Changchun, Jilin, 130021, China
| | - Dan Wang
- Department of Gastroenterology, The First Hospital of Jilin University, 71 Xinmin Street Changchun, Jilin, 130021, China
| | - Hong Xu
- Department of Gastroenterology, The First Hospital of Jilin University, 71 Xinmin Street Changchun, Jilin, 130021, China.
| | - Jian-Guang Zhang
- Department of Gastroenterology, The First Hospital of Jilin University, 71 Xinmin Street Changchun, Jilin, 130021, China.
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Morita K, Yoshioka H, Tanaka K, Sugiura J, Yamamoto R, Goto Y, Yamaki K, Kato W. Intrapericardial bronchogenic cyst extirpated through median sternotomy: a case report. GENERAL THORACIC AND CARDIOVASCULAR SURGERY CASES 2023; 2:20. [PMID: 39516935 PMCID: PMC11533643 DOI: 10.1186/s44215-023-00041-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/22/2023] [Indexed: 11/16/2024]
Abstract
BACKGROUND Bronchogenic cyst sometimes occurs in the mediastinum and rarely in the intrapericardial space. When located in the intrapericardial space, the main vessels or the heart can be compressed. In addition, if it is difficult to deny malignancy or malignancy transformation potential using any modality, surgical resection should be performed. CASE PRESENTATION The patient was a 21-year-old woman with persistent symptoms similar to a cold. Enhanced computed tomography confirmed a 51 × 36 × 35-mm intrapericardial cystic structure with partial calcification. The lesion was large enough to compress and interfere with the venous return of the superior vena cava. Thrombus formation was suspected upstream of the compression site. We performed utter extirpation through median sternotomy. A histopathological examination of the surgical specimen revealed a bronchogenic cyst. The postoperative course was uneventful, and she was discharged on postoperative day 9. CONCLUSION We experienced a case of total extirpation of an intrapericardial bronchogenic cyst complicated with compression of the superior vena cava. Long-term follow-up will be necessary.
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Affiliation(s)
- Koji Morita
- Department of Cardiothoracic Surgery of Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan.
| | - Hiromu Yoshioka
- Department of Thoracic Surgery of Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Keisuke Tanaka
- Department of Cardiothoracic Surgery of Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Junya Sugiura
- Department of Cardiothoracic Surgery of Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Ryota Yamamoto
- Department of Cardiothoracic Surgery of Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Yuki Goto
- Department of Cardiothoracic Surgery of Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Koshi Yamaki
- Department of Cardiothoracic Surgery of Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
| | - Wataru Kato
- Department of Cardiothoracic Surgery of Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Japan
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Grigoroiu M, Paisley S, Brian E, Natali D. Intrathymic growing bronchogenic cyst mimicking thymoma: A case report. Front Oncol 2023; 13:1121321. [PMID: 36890835 PMCID: PMC9986532 DOI: 10.3389/fonc.2023.1121321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 02/03/2023] [Indexed: 02/22/2023] Open
Abstract
Intrathymic bronchogenic cysts are extremely rare lesions, and the differential diagnosis with a banal thymic cyst or a solid tumor can be problematic. Thymic carcinomas arising within thymic cysts have also been reported. We report a case of radical thymectomy for a slowly growing small thymic cyst. The pathological finding revealed a bronchogenic cyst rather than a thymic neoplasm.
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Affiliation(s)
- Madalina Grigoroiu
- Dunarea de Jos University, Galați, Romania.,Antony Private Hospital, Antony, France
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9
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Kang K, Wang S, Li B, Wang M, Xiong F. Single-port thoracoscopic resection of a posterior mediastinal Mullerian cyst in a woman. J Int Med Res 2022; 50:3000605221096275. [PMID: 35574814 PMCID: PMC9251828 DOI: 10.1177/03000605221096275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Mullerian cysts are benign tumors that are very rare in the posterior mediastinum. It is
necessary to distinguish Mullerian cysts from benign tumors or other types of cyst in the
posterior mediastinum. A 42-year-old woman visited our hospital for a routine check-up,
and a mediastinal mass was identified on chest computed tomography (CT). Contrast-enhanced
chest magnetic resonance imaging (MRI) revealed a 4.0 × 2.6 × 2.8-cm mass, and a
neurogenic tumor or esophageal cyst was suspected. Single-port thoracoscopic surgery was
performed for cyst removal. Histopathological examination of the resected tissue revealed
that the cyst wall was covered with a single layer of ciliated columnar epithelium.
Immunohistochemical staining revealed positivity for paired box gene 8 (PAX8), Wilms tumor
protein 1 (WT-1), estrogen receptor (ER), and progesterone receptor (PR). Therefore, a
diagnosis of mediastinal Mullerian cyst was made. Mediastinal Mullerian cysts should be
included in the differential diagnosis of posterior mediastinal cysts. Cystic lesions in
the posterior mediastinum should be removed surgically and undergo immunohistochemical
examination.
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Affiliation(s)
- Kai Kang
- Thoracic Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sheng Wang
- Thoracic Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Binfeng Li
- Thoracic Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Manxiang Wang
- Pathology department, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fei Xiong
- Thoracic Surgery, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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10
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Mohamed S, Patel AJ, Mehdi R, Menon A, Steyn R, Bishay E. Infected mediastinal cysts following endobronchial ultrasound guided biopsy-a case series. J Surg Case Rep 2022; 2022:rjac158. [PMID: 35422985 PMCID: PMC9005207 DOI: 10.1093/jscr/rjac158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/22/2022] [Indexed: 11/14/2022] Open
Abstract
Mediastinal cysts are commonly an incidental finding simulating a benign or malignant diagnosis. Infection is a recognised complication of mediastinal cyst and therefore early surgical management is essential. Endobronchial ultrasound guided biopsy (EBUS) has been used to diagnose and manage mediastinal cyst. We present a case series of three patients who presented with sepsis following diagnostic EBUS of mediastinal cyst. We would recommend that EBUS guided biopsy be applied cautiously if there is a high suspicion of mediastinal cyst to avoid post procedural infection, which can thus complicate any future therapeutic options.
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Affiliation(s)
- Saifullah Mohamed
- Department of Thoracic Surgery, University Hospitals Birmingham, Birmingham, UK
| | - Akshay J Patel
- Department of Thoracic Surgery, University Hospitals Birmingham, Birmingham, UK
| | - Rana Mehdi
- Department of Thoracic Surgery, University Hospitals Birmingham, Birmingham, UK
| | - Ashvini Menon
- Department of Thoracic Surgery, University Hospitals Birmingham, Birmingham, UK
| | - Richard Steyn
- Department of Thoracic Surgery, University Hospitals Birmingham, Birmingham, UK
| | - Ehab Bishay
- Department of Thoracic Surgery, University Hospitals Birmingham, Birmingham, UK
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11
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Transesophageal endoscopic resection of mediastinal cysts (with video). Gastrointest Endosc 2022; 95:642-649.e2. [PMID: 34875257 DOI: 10.1016/j.gie.2021.11.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/13/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Primary mediastinal cysts are infrequent lesions derived from a variety of mediastinal organs or structures. Complete surgical resection is the treatment of choice even in asymptomatic patients to prevent severe adverse events (AEs) and to establish the diagnosis. Transesophageal endoscopic resection of benign mediastinal tumors has been proven feasible. The aim of this study was to evaluate the feasibility, safety, and efficacy of transesophageal endoscopic surgery for mediastinal cysts. METHODS From January 2016 to May 2021, patients with mediastinal cysts who underwent transesophageal endoscopic resection were retrospectively included. Clinicopathologic characteristics, procedure-related parameters, AEs, and follow-up outcomes were analyzed. RESULTS Ten patients with mediastinal cysts were included in this study. The mean cyst size was 3.3 ± 1.3 cm. Histopathology revealed 3 bronchogenic cysts (30.0%), 4 esophageal duplication cysts (40.0%), 2 gastroenteric cysts (20.0%), and 1 lymphatic cyst (10.0%). All procedures were performed uneventfully without conversion to traditional surgery. En-bloc resection was achieved in 6 patients (60.0%). Aggressive resection was avoided to prevent damage to the surrounding vital organs. Mean resection time and suture time were 58.0 ± 36.4 minutes and 5.4 ± 1.0 minutes, respectively. No major pneumothorax, bleeding, mucosal injury, or fistula occurred. One patient had a transient febrile episode (>38.5°C). Mean postoperative hospital stay was 2.7 ± .9 days. No residual or recurrent lesions were observed in any patient during a mean follow-up period of 29.8 ± 19.5 months. CONCLUSIONS Transesophageal endoscopic surgery appears to be a feasible, safe, effective, and much less invasive approach for mediastinal cyst resection. Larger prospective studies are required to fully assess the efficacy and safety of this novel technique.
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12
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Moraitis SD, Agrafiotis AC, Skoura E, Kalkanis D, Moraitis D, Tomos P, Liakakos T, Angouras D. Can the Ratio SUVmax of the Lesion/SUVmax of Mediastinal Tissues Guide the Choice of Surgical Access for the Resection of Thymic Epithelial Tumors? Front Surg 2022; 9:852906. [PMID: 35372481 PMCID: PMC8964615 DOI: 10.3389/fsurg.2022.852906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThere are studies showing the utility of the 18-fluorodeoxyglucose positron emission tomography (18FDG PET) scan in the management of patients with thymic epithelial tumors. It seems to be a correlation between the standard uptake value (SUVmax) of thymic epithelial tumors and the histological type and the stage. This study aims to use the ratio of the SUVmax of the lesion to the SUVmax of the adjacent mediastinal tissues in order to guide the choice of the surgical access.MethodsAll patients who presented an anterior mediastinal lesion with a high suspicion of being of thymic origin were included in a prospective database. A ratio inferior to 1 could predict a benign nature and less aggressive behavior, and a minimally invasive approach was performed. A ratio superior to 1 suggested a malignant and aggressive behavior, and a median sternotomy (or a thoracotomy) was performed.ResultsThere were 15 male (mean age 44.6 ± 16.26 years, range 25–73) and 15 female patients (mean age 50.1 ± 16.94 years, range 25–76). When the ratio is inferior to 1, it predicts benign disease in 80% of cases. When it is superior to 1, it predicts in half of cases advanced histological types (high risk thymomas and thymic carcinomas). On the contrary, it can quite accurately predict advanced Masaoka–Koga stages.ConclusionsThe protocol of this study is in accordance with the current literature showing the utility of 18FDG PET scan in the treatment of thymic epithelial tumors. This study goes one step further since the choice of surgical access is based on the SUVmax values. The ratio SUVmax of the lesion/SUVmax of the mediastinal tissues could be a new marker, more pertinent than absolute SUVmax values.
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Affiliation(s)
- Sotirios D. Moraitis
- Department of Joint Corps Armed Forces Cardiac Surgery, 401 Hellenic Army Hospital, Athens, Greece
- Department of Thoracic Surgery, Athens Naval and Veterans Hospital, Athens, Greece
| | - Apostolos C. Agrafiotis
- Department of Thoracic Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
- *Correspondence: Apostolos C. Agrafiotis
| | | | | | - Dimitrios Moraitis
- Department of Administration, Athens Naval and Veterans Hospital, Athens, Greece
| | - Periklis Tomos
- Department of Thoracic Surgery, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodoros Liakakos
- Department of Surgery, Laikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Angouras
- Department of Cardiac Surgery, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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13
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Agrafiotis AC, Paralikas I, Giakoumakis K, Moraitis SD. Case Report: Diffuse Large B-Cell Lymphoma in the Wall of a Thymic Cyst. Front Surg 2022; 9:788047. [PMID: 35187056 PMCID: PMC8847264 DOI: 10.3389/fsurg.2022.788047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/03/2022] [Indexed: 11/26/2022] Open
Abstract
Thymic cysts are rare lesions (1–5% of all mediastinal masses) and, most of the times, are incidental findings. The coexistence of a lymphoma and a thymic cyst is rare. In the case reported herein, microscopic foci of a diffuse large B-cell lymphoma were identified in the wall of a resected thymic cyst. This case report adds to the current knowledge of this rare entity and highlights the necessity of early surgical resection of mediastinal cysts over watchful waiting.
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Affiliation(s)
- Apostolos C. Agrafiotis
- Department of Thoracic Surgery, Saint-Pierre University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
- *Correspondence: Apostolos C. Agrafiotis
| | - Ioannis Paralikas
- Departmentof Thoracic Surgery, Athens Naval and Veterans Hospital, Athens, Greece
| | - Kanellos Giakoumakis
- Department of Anesthesiology, Athens Naval and Veterans Hospital, Athens, Greece
| | - Sotirios D. Moraitis
- Joint Corps Armed Forces Cardiac Surgery Department, 401 Hellenic Army Hospital, Athens, Greece
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14
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Zhu X, Zhang L, Tang Z, Xing FB, Gao X, Chen WB. Mature mediastinal bronchogenic cyst with left pericardial defect: A case report. World J Clin Cases 2021; 9:11362-11368. [PMID: 35071567 PMCID: PMC8717515 DOI: 10.12998/wjcc.v9.i36.11362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 06/26/2021] [Accepted: 07/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mediastinal bronchogenic cysts and pericardial defects are both rare. It is extremely rare that both occur simultaneously. To the best of our knowledge, this is the first case of a coexistent bronchogenic cyst and pericardial defect reported in China. We performed a literature review and found a relationship between bronchogenic cysts and pericardial defects, which further revealed the correlation between the bronchus and pericardium during embryonic development.
CASE SUMMARY A 14-year-old boy attended a local hospital for ankylosing spondylitis. Chest radiography showed an enhanced circular-density shadow near the left mediastinum. The patient had no chest symptoms and the physical examination was normal. Because of the mediastinal occupation, the patient visited our department of chest surgery for further treatment. During surgery, a left pericardial defect was observed. The bronchogenic cyst was removed by thoracoscopic surgery, but the pericardial defect remained untreated, and a satisfactory outcome was achieved after the operation. The patient was diagnosed with a mediastinal tumor. The pathological diagnosis of the tumor was a bronchogenic cyst.
CONCLUSION This case further reveals the correlation between the bronchus and pericardium during embryonic development.
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Affiliation(s)
- Xiao Zhu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Anhui Province, China
| | - Lei Zhang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Anhui Province, China
| | - Zhen Tang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Anhui Province, China
| | - Fu-Bao Xing
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Anhui Province, China
| | - Xiong Gao
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Anhui Province, China
| | - Wen-Bang Chen
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu 233004, Anhui Province, China
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15
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Singh V, Sudhesh KS, Prasad HL K, Hosmane GB, Gopalakrishnan M, Shetty K J. Unusual Congenital Lesion Masquerading as a Lung Mass in an Adult. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2021. [DOI: 10.1055/s-0041-1736281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractCongenital pulmonary airway malformation (CPAM) is a broad spectrum of congenital cystic lung lesions caused by the arrested bronchoalveolar development. Approximately, 80% of CPAMs are diagnosed prenatally or during the neonatal period when patients present with respiratory failure and cyanosis. CPAM is often associated with other organ anomalies and aplasia, and they have poor prognoses. Many CPAMs are detected in infants and school-age children, and infections like pneumonia trigger these diagnoses. It rarely manifests in adults. These often get missed because of the superadded diseases, and hence, it is essential to have a correct approach to their diagnosis to avoid misdiagnosis.
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Affiliation(s)
- Vartika Singh
- Department of Pathology, K.S. Hegde Medical Academy, Nitte (Deemed to be) University, Mangalore, Karnataka, India
| | - Kotian Shravya Sudhesh
- Department of Pathology, K.S. Hegde Medical Academy, Nitte (Deemed to be) University, Mangalore, Karnataka, India
| | - Kishan Prasad HL
- Department of Pathology, K.S. Hegde Medical Academy, Nitte (Deemed to be) University, Mangalore, Karnataka, India
| | - Giridhar Belur Hosmane
- Department of Pulmonary Medicine, K.S. Hegde Medical Academy, Nitte (Deemed to be) University, Mangalore, Karnataka, India
| | - Mundayat Gopalakrishnan
- Department of CTVS, K.S. Hegde Medical Academy, Nitte University, Mangalore, Karnataka, India
| | - Jayaprakash Shetty K
- Department of Pathology, K.S. Hegde Medical Academy, Nitte (Deemed to be) University, Mangalore, Karnataka, India
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16
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Marcuse F, Hochstenbag M, De Baets MHV, Bootsma G, Maat APWM, Hoeijmakers JGJ, Keijzers M, Abdul Hamid M, De Ruysscher D, Maessen JG. Robotic thymectomy for thymomas: a retrospective follow-up study in the Netherlands. Ann Thorac Surg 2021; 114:1886-1894. [PMID: 34736927 DOI: 10.1016/j.athoracsur.2021.09.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/18/2021] [Accepted: 09/23/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Maastricht University Medical Center+ (MUMC+) is a Dutch center of expertise, appointed by the Netherlands Federation of University Medical Centres (NFU), for the treatment of thymomas. The aim of this study was to investigate the long-term oncological-, surgical-, and neurological outcomes of all patients who underwent a robotic thymectomy for a thymoma at the MUMC+. METHODS We retrospectively analyzed the clinical-pathological data of all consecutive patients with a thymoma who underwent robotic thymectomy using the DaVinci® Robotic System at the MUMC+ between April 2004 and December 2018. Follow-up data were collected from 60 referring Dutch hospitals. RESULTS In total, 398 robotic thymectomies were performed and 130 thymomas (32.7%) were found. Median follow-up time, procedure time and hospitalization were 46 months, 116 minutes and 3 days, respectively. In 8.4% of the patients a conversion was performed and in 20.8% a complication was registered. The majority of myasthenic patients with a thymoma went into remission, mostly within 12 to 24 months after thymectomy (81.0%). No statistical difference was found in the number of complications, conversions, incomplete resections or deaths between patients with myasthenia gravis and nonmyasthenic patients. Thirty-six patients (27.7%) underwent postoperative radiotherapy. The recurrence rate was 9.1% and the five-year thymoma-related survival rate was 96.6% . CONCLUSIONS Robotic thymectomy was found to be safe and feasible in early-stage thymomas, most advanced-stage thymomas and thymomatous myasthenia gravis. A national guideline could contribute to the improvement of the oncological follow-up of thymic epithelial tumors in the Netherlands.
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Affiliation(s)
- Florit Marcuse
- Department of Pulmonology, Maastricht University Medical Center+, Maastricht, Netherlands.
| | - Monique Hochstenbag
- Department of Pulmonology, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Marc H V De Baets
- School for Mental Health and Neuroscience, Maastricht University+, Maastricht, Netherlands; Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Gerben Bootsma
- Department of Pulmonology, Zuyderland Medical Center, Heerlen, Netherlands
| | - Alexander P W M Maat
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | - Janneke G J Hoeijmakers
- School for Mental Health and Neuroscience, Maastricht University+, Maastricht, Netherlands; Department of Neurology, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Marlies Keijzers
- Department of Vascular Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Myrurgia Abdul Hamid
- Department of Pathology, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Dirk De Ruysscher
- Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht, Netherlands
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17
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Bajoras V, Jagelavičius Ž, Balčiūnaitė G, Wong I, Gruslys V, Ringaitienė D, Davidavičius G. Think outside the coronary artery: Extremely rare case of STEMI in young man. Echocardiography 2021; 38:1836-1840. [PMID: 34510538 DOI: 10.1111/echo.15185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/31/2021] [Accepted: 07/29/2021] [Indexed: 12/01/2022] Open
Abstract
Acute myocardial infarction caused by a bronchogenic cyst is a very rare pathology. It occurs as a result of external compression of the coronary artery by the cyst, leading to myocardial ischemia. The present case illustrates that a bronchogenic cyst, which is generally considered to be a chronic disease entity with gradual onset of symptoms, can manifest acutely as a life-threatening condition. Timely invasive coronary intervention is critical in the acute management of this complication while multimodality imaging assessment is essential in the subsequent management of the underlying etiology.
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Affiliation(s)
- Vilhelmas Bajoras
- The Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania.,The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Žymantas Jagelavičius
- The Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Giedrė Balčiūnaitė
- The Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Ivan Wong
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Vygantas Gruslys
- The Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Donata Ringaitienė
- The Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Giedrius Davidavičius
- The Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
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18
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Gokce A, Hatipoglu M, Kandemir NO, Akkas Y. Thoracic incidentaloma in a chest computed tomography scan of a patient with COVID-19. Br J Hosp Med (Lond) 2021; 82:1-3. [PMID: 34191564 DOI: 10.12968/hmed.2021.0295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Anil Gokce
- Department of Thoracic Surgery, University of Health Sciences, Ankara City Hospital, Bilkent, Ankara, Turkey
| | - Merve Hatipoglu
- Department of Thoracic Surgery, University of Health Sciences, Ankara City Hospital, Bilkent, Ankara, Turkey
| | - Nilüfer O Kandemir
- Department of Pathology, University of Health Sciences, Ankara City Hospital, Bilkent, Ankara, Turkey
| | - Yucel Akkas
- Department of Thoracic Surgery, University of Health Sciences, Ankara City Hospital, Bilkent, Ankara, Turkey
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19
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Liu W, Wang Y, Zhang W, Wu H, Liu Z. Pneumonia, pleurisy, mediastinitis, and mediastinal cyst infection secondary to endobronchial ultrasound-guided transbronchial needle aspiration: A case report. Medicine (Baltimore) 2021; 100:e25973. [PMID: 34011084 PMCID: PMC8137064 DOI: 10.1097/md.0000000000025973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/28/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is less commonly used in nonmalignant diseases. In particular, its application in mediastinal cystic lesions has been reported less frequently. EBUS-TBNA is a reassuringly safe procedure with an overall complication rate less than 2%, and serious adverse event rate of 0.14% to 0.16%. The most common complications are infections (mediastinal cyst infection most seen). PATIENT CONCERNS A 28-year-old male presented to the hospital with mediastinal cyst that was incidentally discovered by computed tomography. There was no past history of the patient reviewed. DIAGNOSIS The cyst was identified as a round, anechoic structure by EBUS and serous fluid was aspirated. The carcino-embryonic antigen, mycobacterium tuberculosis DNA and cultures in the fluid were negative. Cytology analysis showed lots of lymphocytes and no malignant cells. The diagnosis of lymphangioma was confirmed based on the computed tomography and EBUS presentation, the nature of the aspirated fluid and the large number of mature lymphocytes within the cystic fluid. INTERVENTIONS Twenty-six hours after EBUS-TBNA, the patient complained of a fever with the highest temperature of 39°C, accompanied by a right-side chest pain, no other symptoms of were reported. The following examinations confirmed the diagnosis of pneumonia, pleurisy, mediastinitis and mediastinal cyst infection, while cultures from cyst and right pleural effusion were both negative. The patient was treated with Teicoplanin+Imipenem/cilastatin, and ultrasound guided transcutaneous catheterization drainage of mediastinal cyst and pleural effusion were performed. OUTCOMES Seven days after the treatments, the patient's symptoms resolved, the complete blood count, C-reactive protein, erythrocyte sedimentation rate were lowered. The size of the cyst was slightly reduced on 17 June compared to that before EBUS-TBNA. Although the surgical resection of the cyst was recommended, the patient declined. After extracted the two drainage tubes, the patient was discharged on June 22. The patient was followed up by telephone 6 months after discharge and he remained asymptomatic. CONCLUSIONS EBUS-TBNA is a useful diagnostic and therapeutic tool for the management of mediastinal cysts. However, considering the possibility of serious complications, the clinical procedure should be carried out scrupulously with appropriate patient selection and strict aseptic principles.
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Affiliation(s)
- Wei Liu
- Department of Pulmonary and Critical Care Medicine, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha
| | - Yongxue Wang
- Department of Pulmonary and Critical Care Medicine, The First People's Hospital of Yueyang, Yueyang, Hunan, P.R. China
| | - Weidong Zhang
- Department of Pulmonary and Critical Care Medicine, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha
| | - Huaiqiu Wu
- Department of Pulmonary and Critical Care Medicine, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha
| | - Zhiguang Liu
- Department of Pulmonary and Critical Care Medicine, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha
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20
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Alzahran A, Shebli B, Dabbas S, Sawas J, Khalili J, Zaki Karzoun M, Alhasan A, Abdullah M. Rare mediastinal thymic cyst infection without predisposing disease: a case report. JRSM Open 2021; 12:2054270421991801. [PMID: 33959302 PMCID: PMC8062853 DOI: 10.1177/2054270421991801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Ayham Alzahran
- Faculty of Medicine, University of Aleppo, 15310 Aleppo, Syria
| | - Baraa Shebli
- Faculty of Medicine, University of Aleppo, 15310 Aleppo, Syria
| | - Sidra Dabbas
- Faculty of Medicine, University of Aleppo, 15310 Aleppo, Syria
| | - Joudi Sawas
- Faculty of Medicine, University of Aleppo, 15310 Aleppo, Syria
| | - Joud Khalili
- Faculty of Medicine, University of Aleppo, 15310 Aleppo, Syria
| | - M Zaki Karzoun
- Department of Pathology, Aleppo University Hospital, University of Aleppo, 15310 Aleppo, Syria
| | - Areej Alhasan
- Department of Pediatrics, Aleppo University Hospital, University of Aleppo, 15310 Aleppo, Syria
| | - Manar Abdullah
- Department of Pediatrics, Aleppo University Hospital, University of Aleppo, 15310 Aleppo, Syria
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21
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Liu J, Lv Q, Wang J, Zhang L, Xie M, Yang Y. Diagnostic value of echocardiography in paracardiac cystic lesions: 43 cases from one single medical center. Int J Cardiovasc Imaging 2021; 37:1961-1966. [PMID: 33620608 PMCID: PMC8255260 DOI: 10.1007/s10554-021-02180-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 01/30/2021] [Indexed: 12/25/2022]
Abstract
Paracardial cystic lesions (PCLs) are rare, benign lesions and may occur in any part surrounding the heart. It covers a variety of pathological types, including pericardial cysts, thymic cysts, bronchogenic cysts and so on. The aim of this study was to summarize the diagnostic value of echocardiography in different pathological types of the PCLs. Echocardiographic features of 43 consecutive PCL patients treated at the Union Hospital from January 2002 to December 2017 were compared and analyzed with their surgical and pathological findings retrospectively. The PCLs included 19 pericardial cysts, 12 thymic cysts, 7 bronchogenic cysts, 3 cystic teratomas, 1 enteric cyst and 1 lymphangioma. Among them, 29 cases (67.4%) were accurately diagnosed by echocardiography and 14 cases (32.6%) were missed the diagnosis. All diagnosed cysts were showed as thin-walled, monolocular, echo-free structures without blood flow signals in echocardiographic images. 4 patients had compression of the heart and great vessels caused by cysts. In addition, 4 intracardiac lesions were diagnosed by echocardiography and the results were further confirmed in surgery. Echocardiography is of great value in the diagnosis of paracardiac cystic lesions as well as combined intracardiac lesions. Differential diagnosis could be mainly made based on the location of the lesions.
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Affiliation(s)
- Jinfeng Liu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Department 3 of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Qing Lv
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Jing Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
| | - Yali Yang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
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22
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Noori NM, Shafighi Shahri E, Soleimanzadeh Mousavi SH. Large Congenital Pericardial Cyst Presented by Palpitation and Left Ventricle Posterior Wall Compression: A Rare Case Report. Pediatr Rep 2021; 13:57-64. [PMID: 33467404 PMCID: PMC7839019 DOI: 10.3390/pediatric13010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/16/2020] [Indexed: 11/24/2022] Open
Abstract
Congenital pericardial cysts are rare anomalies caused by the failure of fetal lacunae to coalesce into pericardial coelom. In this article a 9-year-old boy admitted with complain of palpitation in daily activities. The electrocardiography detected sinus tachycardia of 150 beats per minute with normal axis. Although chest X ray were normal, echocardiography showed an abnormal mass that compressed the posterior wall of left ventricle. The mass was extrinsic and confined to the pericardium. After midsternotomy, a huge cyst was found and totally excised. The complications of pericardial cyst can be significant, and the diagnosis relies on a careful examination and radiographic findings.
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23
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Garrana SH, Rosado-de-Christenson ML. Imaging of the Anterior/Prevascular Mediastinum. Radiol Clin North Am 2021; 59:155-168. [PMID: 33551078 DOI: 10.1016/j.rcl.2020.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Prevascular mediastinal masses include a wide range of benign and malignant entities. Localization of mediastinal masses to specific compartments together with characteristic imaging findings and demographic and clinical information allows formulation of a focused differential diagnosis. Radiologists may use these methods to distinguish between surgical and nonsurgical cases and thus inform patient management and have an impact on outcomes. Treatment of choice varies based on the pathology, ranging from no intervention or serial imaging follow-up to surgical excision, chemotherapy, and/or radiation.
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Affiliation(s)
- Sherief H Garrana
- Department of Radiology, Saint Luke's Hospital of Kansas City, 4401 Wornall Road, Kansas City, MO 64111, USA; University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, USA.
| | - Melissa L Rosado-de-Christenson
- Department of Radiology, Saint Luke's Hospital of Kansas City, 4401 Wornall Road, Kansas City, MO 64111, USA; University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, USA
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24
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Goitein O, Truong MT, Bekker E, Marom EM. Potential Pitfalls in Imaging of the Mediastinum. Radiol Clin North Am 2021; 59:279-290. [PMID: 33551087 DOI: 10.1016/j.rcl.2020.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Chest computed tomography (CT) is the modality of choice for mediastinal imaging. The high-resolution images provided by multi-detector CT result in routine visualization of normal anatomic structures, which can be confused with pathology. In addition, many mediastinal abnormalities are discovered incidentally, with a routine chest CT protocol which may be insufficient for definite diagnosis. Awareness of the spectrum of potential pitfalls of mediastinal imaging, artifacts related to flow, motion, and solutions to mitigate these problematic issues is important in accurate interpretation. The purpose of this review is to highlight and discuss potential pitfalls in the imaging of the mediastinum.
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Affiliation(s)
- Orly Goitein
- Department of Diagnostic Imaging, Division of Cardiovascular Imaging, The Chaim Sheba Medical Center (affiliated with Tel Aviv University), Derech Sheba 2, Ramat Gan, Israel.
| | - Mylene T Truong
- Department of Diagnostic Imaging, Division of Thoracic Imaging, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Elena Bekker
- Department of Diagnostic Imaging, Division of Cardiovascular Imaging, The Chaim Sheba Medical Center (affiliated with Tel Aviv University), Derech Sheba 2, Ramat Gan, Israel; Department of Diagnostic Imaging, Division of Thoracic Imaging, The Chaim Sheba Medical Center (affiliated with Tel Aviv University), Derech Sheba 2, Ramat Gan, Israel
| | - Edith M Marom
- Department of Diagnostic Imaging, Division of Thoracic Imaging, The Chaim Sheba Medical Center (affiliated with Tel Aviv University), Derech Sheba 2, Ramat Gan, Israel
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25
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Role of Interventional Pulmonology in Miscellaneous Conditions. Respir Med 2021. [DOI: 10.1007/978-3-030-80298-1_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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26
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Role of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration in the Diagnosis and Management of Mediastinal Cyst. J Bronchology Interv Pulmonol 2020; 27:142-146. [PMID: 31855882 DOI: 10.1097/lbr.0000000000000640] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Foregut cysts account for >50% of cystic lesions in the mediastinum, of which bronchogenic cysts are most common. Surgical resection is the most definitive approach for its diagnosis and treatment. A recent systematic review, however, suggests that endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has a role in the management of bronchogenic cyst. We report our experience with EBUS-TBNA in the diagnosis and management of bronchogenic cysts. METHODS Medical records of patients with evidence of mediastinal cysts who underwent EBUS-TBNA between 2008 and 2016 were reviewed.The primary aims of this study were to assess EBUS-TBNA diagnostic yield of peri-bronchial cysts and their specific type/origin and to determine its short-term and long-term drainage efficacy. RESULTS A total of 26 patients met the inclusion criteria. The cytopathology diagnosis was compatible with bronchogenic cyst in 4 cases, pleural-pericardial cyst in 3 cases, and 19 were indeterminate cysts. Successful long-term treatment occurred in 5.5% of the subjects. One patient developed inflammatory pericarditis after EBUS-TBNA. CONCLUSION Diagnostic and therapeutic yield of EBUS-TBNA for mediastinal cysts is limited and surgical resection remains the treatment of choice.
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27
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Damaskos C, Garmpis N, Garmpi A, Georgakopoulou VE, Tomos P. Multilocular Thymic Cyst in a Young, Otherwise Healthy Woman: A Case Report. Cureus 2020; 12:e11210. [PMID: 33269141 PMCID: PMC7704160 DOI: 10.7759/cureus.11210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Thymic cysts are rare lesions, accounting approximately for 1% of all mediastinal masses. We report a case of a 36-year old woman who presented preoperatively with a calcified mass shadow found on a routine chest radiograph X-ray. After further investigation with chest computed tomography (CT), magnetic resonance imaging (MRI), and tests for Myasthenia gravis, a benign mediastinal cyst was diagnosed and the patient underwent median sternotomy and complete surgical excision of the lesion. The histological examination described a multilocular thymic cyst. Thymic cysts are usually associated with thymic epithelial tumors, such as thymomas, or multisystemic morbid conditions such as human immunodeficiency virus (HIV) infection, rheumatologic disease, and Myasthenia gravis. At all follow-up examinations to date, the patient remains healthy.
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Affiliation(s)
- Christos Damaskos
- Renal Transplantation Unit, Laiko General Hospital, Athens, GRC.,Medicine, N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Athens, GRC
| | - Nikolaos Garmpis
- Second Department of Propedeutic Surgery, Laiko General Hospital, Athens, GRC.,Medicine, National and Kapodistrian University of Athens, Athens, GRC
| | - Anna Garmpi
- First Department of Propedeutic Internal Medicine, Laiko General Hospital, Athens, GRC.,Medicine, National and Kapodistrian University of Athens, Athens, GRC
| | - Vasiliki E Georgakopoulou
- Pulmonology Department, Laiko General Hospital, Athens, GRC.,First Pulmonology Department, Sismanogleio Hospital, Athens, GRC
| | - Periklis Tomos
- Department of Thoracic Surgery, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, GRC
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28
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Abstract
Primary mediastinal cysts are infrequent lesions that can arise from a variety of mediastinal organs or structures. Most of these are congenital in origin and incidental findings during investigations for unrelated conditions. Histologically, the cysts may be composed of various tissues, including bronchogenic, pericardial, thymic, enteric, Müllerian, lymphatic, and parathyroid types. Mediastinal cysts typically demonstrate a benign clinical course and patients are cured after complete surgical resection. In this review, the embryogenesis, clinical, radiologic, and pathologic characteristics of non-neoplastic mediastinal cysts are examined with discussion of the role of immunohistochemistry and the most pertinent differential diagnosis.
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Cystic Lesions of Anterior Mediastinum: Case Report. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2020. [DOI: 10.2478/sjecr-2018-0061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Cystic lesions of the mediastinum are uncommon, comprising 12% to 18% of all primary mediastinal tumors and unless they attain a large size and cause compressive symptoms, these tumors are generally asymptomatic and are discovered incidentally upon radiologic investigation of some other condition.
We present in this paper a case of cystic lesions of the mediastinum in a 70-year-old male patient who underwent a surgery for mediastinal mass removal. Histopathology report had shown it was the case of mature cystic teratoma of anterior mediastinum.
Based on a review of the literature, as well as our experience, we conclude that best treatment for cystic lesions of anterior mediastinum is complete surgical resection if possible.
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Wang X, Li Y, Chen K, Yang F, Wang J. Clinical characteristics and management of primary mediastinal cysts: A single-center experience. Thorac Cancer 2020; 11:2449-2456. [PMID: 32677753 PMCID: PMC7471030 DOI: 10.1111/1759-7714.13555] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/06/2020] [Accepted: 06/08/2020] [Indexed: 12/16/2022] Open
Abstract
Background In this study we aimed to assess the clinical outcomes of performing video‐assisted thoracic surgery (VATS) to treat primary mediastinal cysts (PMCs) and investigate the clinical factors which increase the difficulties associated with VATS. Methods The medical records of all consecutive PMC patients, who underwent surgical resection from April 2001 to July 2016, were reviewed and 282 patients were included. Clinical characteristics, imaging features, and surgical outcomes were analyzed. Follow‐up data were successfully obtained from 230 PMC patients by telephone or outpatient clinic annually. The latest follow‐up was July 2019. Results VATS was performed in 278 patients and four patients were converted into thoracotomy. The mean operation time and intraoperative bleeding were 102.4 ± 40.9 minutes (range 25–360 minutes) and 52.4 ± 75.1 mL (range 5–600 mL), respectively. The intra‐ and postoperative complication rates were 2.8 and 5.7%, respectively. Seven patients with bronchogenic cysts showed severe cyst adhesion to vital mediastinal structures and thus had incomplete resection. Multivariable logistic analysis revealed that a maximal cyst diameter greater than 5 cm was significantly associated with increased risks of operation time extension (OR = 2.106; 95% CI: 1.147–3.865, P = 0.016) and intraoperative blood loss increase (OR = 4.428; 95% CI: 1.243–16.489, P = 0.022). A total of 230 patients had follow‐up data. The median follow‐up time was 70 months (range, 36–210 months). No local recurrence was observed. Conclusions Surgical resection by VATS may be recommended for PMC management as a primary therapeutic strategy. Cysts with a maximum diameter greater than 5 cm or cysts adjacent to vital mediastinal structures can increase the surgical difficulties. Key points • Significant findings of the study A diameter >5 cm and adhesions significantly increased the risk of operation time extension together with increased blood loss. • What this study adds Cysts with a diameter >5 cm or those adjacent to vital mediastinal structures increased the potential for surgical difficulties.
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Affiliation(s)
- Xun Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Yun Li
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Kezhong Chen
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Fan Yang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Jun Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
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Ramireddy K, Golamari RR, Minupuri A, Zheng S, Menetrey J. Bronchogenic Cyst Presenting as Acute Pericarditis. Cureus 2020; 12:e8874. [PMID: 32617249 PMCID: PMC7325378 DOI: 10.7759/cureus.8874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Bronchogenic cysts are speculated to arise from abnormal budding of the foregut tissue during embryogenesis. Around 90% of mediastinal bronchogenic cysts are asymptomatic, and a small percentage of them present with chest pain and dyspnea. Pericardial effusion is one of the manifestations described; however, pericarditis has not been widely reported. We describe a case of a bronchogenic cyst in a 19-year-old female with an initial presentation of pericarditis due to mechanical impingement. There was an associated trace to small pericardial effusion. The bronchogenic cyst was planned to be excised; however, it could only be partially excised due to its adherence to the left atrium.
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Affiliation(s)
| | - Reshma R Golamari
- Internal Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, USA
| | - Arun Minupuri
- Internal Medicine, Mercy Catholic Medical Center, Darby, USA
| | - Shengnan Zheng
- Internal Medicine, Mercy Catholic Medical Center, Darby, USA
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Fievet L, Gossot D, de Lesquen H, Calabre C, Merrot T, Thomas P, Becmeur F, Grigoroiu M. Resection of Bronchogenic Cysts in Symptomatic Versus Asymptomatic Patients: An Outcome Analysis. Ann Thorac Surg 2020; 112:1553-1558. [PMID: 32599038 DOI: 10.1016/j.athoracsur.2020.05.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 04/19/2020] [Accepted: 05/01/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The natural evolution of bronchogenic cysts (BCs) is unpredictable. Although most surgeons agree that symptomatic BCs should be resected, questions remain regarding the optimal management of asymptomatic mediastinal cysts. We present a case series of BCs to compare patients who underwent preventive operation with those who underwent surgical procedure after symptom onset. METHODS This 15-year multicenter retrospective study included 114 patients (32 children and 82 adults). Data on clinical history, pathology, mean hospital stay, intraoperative and postoperative complications, and associated intraoperative procedures were analyzed separately for symptomatic and asymptomatic patients. RESULTS A total of 53 asymptomatic patients (46.5%) were compared with 61 symptomatic patients (53.5%). There were significantly more adults in the symptomatic group than in the asymptomatic group (48 vs 34 patients, P < .05). A thoracoscopic approach was used in 88 patients (77%), with 7 conversions to thoracotomy (9%), all in symptomatic patients. There were significantly more additional procedures (20% vs 4%, P = .01) and more intraoperative complications (20% vs 4%, P = .01) in symptomatic patients, but postoperative complications between symptomatic and asymptomatic patients were similar. The postoperative length of stay was significantly longer in symptomatic patients (5.71 days vs 4 days, P < .001). Pathologic examination found significantly more inflammatory reactions in symptomatic patients. CONCLUSION Early surgical management of BCs may be recommended to prevent symptomatic complications, which are unpredictable and whose management is more complicated in advanced BCs. Surgery can be performed with a thoracoscopic approach, which is easier and safer when the cyst is small and uncomplicated.
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Affiliation(s)
- Lucile Fievet
- Department of Pediatric Surgery, Centre Hospitalier Régional Henri Duffaut, Provence-Alpes-Côte d'Azur, Avignon, France.
| | - Dominique Gossot
- Department of Thoracic Surgery, Institut Mutaliste Montsouris, Île de France, Paris, France
| | - Henri de Lesquen
- Department of Thoracic Surgery, North Hospital, Assistance Publique-Hôpitaux de Marseille, Provence-Alpes-Côte d'Azur, Marseille, France
| | - Charline Calabre
- Department of Pediatric Surgery, Centre Hospitalier Régional Universitaire Strasbourg, Alsace, France
| | - Thierry Merrot
- Department of Pediatric Surgery, La Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Provence-Alpes-Côte d'Azur, Marseille, France
| | - Pascal Thomas
- Department of Thoracic Surgery, North Hospital, Assistance Publique-Hôpitaux de Marseille, Provence-Alpes-Côte d'Azur, Marseille, France
| | - François Becmeur
- Department of Pediatric Surgery, Centre Hospitalier Régional Universitaire Strasbourg, Alsace, France
| | - Madalina Grigoroiu
- Department of Thoracic Surgery, Institut Mutaliste Montsouris, Île de France, Paris, France
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He WT, Deng JY, Liang H, Xiao JY, Cao FL. Bronchogenic cyst of the stomach: A case report. World J Clin Cases 2020; 8:1525-1531. [PMID: 32368546 PMCID: PMC7190944 DOI: 10.12998/wjcc.v8.i8.1525] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 03/27/2020] [Accepted: 04/10/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gastric bronchogenic cysts (BCs) are extremely rare cystic masses caused by abnormal development of the respiratory system during the embryonic period. Gastric bronchial cysts are rare lesions first reported in 1956; as of 2019, only 37 cases are available in the MEDLINE/PubMed online databases. BCs usually have no clinical symptoms in the early stage, and their imaging findings also lack specificity. Therefore, they are difficult to diagnose before histopathological examination. CASE SUMMARY A 55-year-old woman presented at our hospital with intermittent epigastric pain. She had a slightly high level of serum carbohydrate antigen 72-4 (CA 72-4). Endoscopic ultrasound found that a cystic mass originated from the submucosa of the posterior gastric wall near the cardia, indicating a diagnosis of cystic hygroma of the stomach. Furthermore, a computed tomography scan demonstrated a quasi-circular cystic mass closely related to the lesser curvature of the gastric fundus with a low density. Because the imaging examinations did not suggest a malignancy and the patient required complete resection, she underwent laparoscopic surgery. As an intraoperative finding, this cystic lesion was located in the posterior wall of the fundus and contained some yellow viscous liquid. Finally, the pathologists verified that the cyst in the fundus was a gastric BC. The patient recovered well with normal CA 72-4 levels, and her course was uneventful at 10 mo. CONCLUSION This is a valuable report as it describes an extremely rare case of gastric BC. Moreover, this is the first case of BC to present with elevated CA 72-4 levels.
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Affiliation(s)
- Wen-Ting He
- Department of Gastroenterology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, and Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
| | - Jing-Yu Deng
- Department of Gastroenterology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, and Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
| | - Han Liang
- Department of Gastroenterology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, and Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
| | - Jian-Yu Xiao
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, and Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
| | - Fu-Liang Cao
- Department of Endoscopy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, and Tianjin’s Clinical Research Center for Cancer, Tianjin 300060, China
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Betraoui F. [An unusual mass]. Rev Mal Respir 2020; 37:346-348. [PMID: 32278509 DOI: 10.1016/j.rmr.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/12/2020] [Indexed: 11/19/2022]
Affiliation(s)
- F Betraoui
- Service de pneumologie, centre hospitalier de Tourcoing, 155, rue du Président-Coty, 59200 Tourcoing, France.
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Taniguchi D, Tsuchiya T, Matsumoto K, Miyazaki T, Hatachi G, Tomoshige K, Doi R, Watanabe H, Zaizen Y, Fukuoka J, Nagayasu T. A case of emergent operation for a life-threatening infectious mediastinal cyst. Int J Surg Case Rep 2019; 64:150-153. [PMID: 31655286 PMCID: PMC6831818 DOI: 10.1016/j.ijscr.2019.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/04/2019] [Accepted: 10/10/2019] [Indexed: 10/31/2022] Open
Abstract
PURPOSE Congenital mediastinal cysts are an uncommon but important diagnostic group. Most of these cysts are benign and asymptomatic in adults. However, some of them are clinically problematic due to the compression of neighboring organs, infection, or perforation. CASE PRESENTATION A 20-year-old man presented with severe dyspnea. Imaging revealed a mediastinal cyst in the subcarinal space compressing his right pulmonary artery and airway, which was later diagnosed as a bronchogenic cyst. Due to quick symptom exacerbation, emergent cyst wall fenestration was performed through video-assisted thoracic surgery with "stand-by" extracorporeal membrane oxygenation. Complete cyst resection was difficult owing to adhesion of the cyst to the surrounding organs. The symptoms immediately resolved after surgery and the postoperative course was uneventful. CONCLUSION Mediastinal bronchogenic cysts with life-threatening complications are rarely reported in adults. However, this case was life-threatening due to airway and vascular compression; emergent surgical care should be considered in such cases.
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Affiliation(s)
- Daisuke Taniguchi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Medical-Engineering Hybrid Professional Development Program, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Tomoshi Tsuchiya
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Keitaro Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Medical-Engineering Hybrid Professional Development Program, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takuro Miyazaki
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Go Hatachi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Medical-Engineering Hybrid Professional Development Program, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Koichi Tomoshige
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ryoichiro Doi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hironosuke Watanabe
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoshiaki Zaizen
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Junya Fukuoka
- Department of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan; Medical-Engineering Hybrid Professional Development Program, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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CT and MRI characteristics for differentiating mediastinal Müllerian cysts from bronchogenic cysts. Clin Radiol 2019; 74:976.e19-976.e25. [PMID: 31551148 DOI: 10.1016/j.crad.2019.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 08/20/2019] [Indexed: 11/23/2022]
Abstract
AIM To evaluate how computed tomography (CT) and magnetic resonance imaging (MRI) characteristics can be used to differentiate immunohistochemically confirmed mediastinal Müllerian cysts (MMCs) from bronchogenic cysts (BCs). MATERIALS AND METHODS Sixteen patients with histopathologically and immunohistochemically confirmed mediastinal cysts (four with MMCs and 12 with BCs) were included in this study. CT and MRI images were reviewed retrospectively and the location, size, CT attenuation, and MRI signal intensity of the two pathologies were compared. RESULTS On review of CT images, cysts could be located to the anterior mediastinum in four BCs, middle mediastinum in three MMCs and seven BCs, and posterior mediastinum in one MMC and one BC. Contact with a vertebral body was observed in 4/4 MMCs (100%) and 6/12 BCs (50%). The ratios of minimum-to-maximum diameter (0.57±0.09 versus 0.74±0.11, p<0.01), CT attenuation (7.8±6 versus 44.3±12 HU, p<0.01), and cyst-to-spinal cord signal intensity ratios (SIRs) on T1-weighted images (0.56±0.2 versus 1.31±0.4, p<0.01) were significantly lower for MMCs than BCs. No significant differences in maximum diameter, minimum diameter, and SIRs on T2-weighted images were found between MMCs and BCs. CONCLUSION In characterising mediastinal cysts in a middle-aged female patient, contact with a vertebral body, flattened configuration, hypodensity on CT, and hypointensity compared to spinal cord on T1-weighted images are features that are specific to MMCs.
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Mortman KD, Law N, Hashemi-Zonouz T. Incidental Mediastinal Thyroid Cancer. Surg Case Rep 2019. [DOI: 10.31487/j.scr.2019.04.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Cystic mediastinal masses are most commonly benign congenital lesions. Rarely, a cystic mediastinal mass will prove to be malignant. The patient, a 50-year-old woman who initially presented with uveitis, was incidentally found to have a right paratracheal opacity on chest X-ray (CXR). Chest computed tomography (CT) demonstrated a 5cm right paratracheal hypodense cystic mass. The patient underwent a right robotic-assisted thoracoscopic resection of the mediastinal mass. Final pathology revealed a 4.5cm mass consistent with metastatic papillary thyroid carcinoma (similar histology in 2 excised lymph nodes). The patient subsequently had a total thyroidectomy with central and right neck dissections.
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A New Tool for an Old Disease: Endotracheal Cyst Diagnosed by EBUS. J Bronchology Interv Pulmonol 2019; 25:e16-e17. [PMID: 29561398 DOI: 10.1097/lbr.0000000000000424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jiang N, Lu Y, Wang J. Is single-port video-assisted thoracic surgery for mediastinal cystectomy feasible? J Cardiothorac Surg 2019; 14:18. [PMID: 30670039 PMCID: PMC6343290 DOI: 10.1186/s13019-019-0843-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 01/14/2019] [Indexed: 11/26/2022] Open
Abstract
Background Video-assisted thoracic surgery (VATS) for mediastinal cysts has been used with increasing frequency. Both single-port VATS and three-port VATS procedures are used for mediastinal cystectomy. Few studies have been published to compare three-port VATS and single-port VATS procedures in mediastinal cystectomy. Methods Forty-five patients with mediastinal cysts who underwent single-port procedures (n = 23) or three-port procedures (n = 22) in our department from January 2016 to July 2018 were retrospectively analysed. The perioperative conditions and pathological findings were analysed. Results The single-port group showed shorter operation times [45 (35–60) vs 55 (45–80) min, p = 0.013], less retention time of the thoracic drainage tube [27(24–48) vs 48(48–70) p < 0.001)], shorter postoperative hospital stays [5(4–6) vs 7(5–7), p = 0.011] and less costs [2.0)1.2–2.5) vs 2.5(1.9–3.5), p = 0.032] than those of the three-port group. No difference was found in case conversions to open procedures (p > 0.99) or second operations (p > 0.99). Logistic regression analysis showed that the surgical method (p = 0.426) and surgeon experience (p = 0.719) were not independent prognostic factors for the success of surgery. Conclusions The single-port VATS procedure was not inferior to the three-port VATS procedure for mediastinal cystectomy. The single-port VATS procedure is a feasible choice for mediastinal cystectomy.
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Affiliation(s)
- Nanqing Jiang
- Department of Cardiothoracic Surgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, 185 Juqian Road, Changzhou, 213003, Jiangsu, China
| | - Yiming Lu
- Department of Cardiothoracic Surgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, 185 Juqian Road, Changzhou, 213003, Jiangsu, China
| | - Jun Wang
- Department of Cardiothoracic Surgery, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, 185 Juqian Road, Changzhou, 213003, Jiangsu, China.
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Annunziata F, Bush A, Borgia F, Raimondi F, Montella S, Poeta M, Borrelli M, Santamaria F. Congenital Lung Malformations: Unresolved Issues and Unanswered Questions. Front Pediatr 2019; 7:239. [PMID: 31249823 PMCID: PMC6584787 DOI: 10.3389/fped.2019.00239] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/28/2019] [Indexed: 12/30/2022] Open
Abstract
Advances in prenatal and postnatal diagnosis, perioperative management, and postoperative care have dramatically increased the number of scientific reports on congenital thoracic malformations (CTM). Nearly all CTM are detected prior to birth, generally by antenatal ultrasound. After delivery, most infants do well and remain asymptomatic for a long time. However, complications may occur beyond infancy, including in adolescence and adulthood. Prenatal diagnosis is sometimes missed and detection may occur later, either by chance or because of unexplained recurrent or persistent respiratory symptoms or signs, with difficult implications for family counseling and substantial delay in surgical planning. Although landmark studies have been published, postnatal management of asymptomatic children is still controversial and needs a resolution. Our aim is to provide a focused overview on a number of unresolved issues arising from the lack of an evidence-based consensus on the management of patients with CTM. We summarized findings from current literature, with a particular emphasis on the vigorous controversies on the type and timing of diagnostic procedures, treatments and the still obscure relationship between CTM and malignancies, a matter of great concern for both families and physicians. We also present an algorithm for the assessment and follow-up of CTM detected either in the antenatal or postnatal period. A standardized approach across Europe, based on a multidisciplinary team, is urgently needed for achieving an evidence-based management protocol for CTM.
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Affiliation(s)
- Federica Annunziata
- Division of Paediatrics, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Andrew Bush
- Department of Paediatrics and Paediatric Respiratory Medicine, Imperial College and Royal Brompton Hospital, London, United Kingdom
| | - Francesco Borgia
- Divisions of Cardiology and Cardiothoracic Surgery, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Francesco Raimondi
- Division of Paediatrics, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Silvia Montella
- Division of Paediatrics, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Marco Poeta
- Division of Paediatrics, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Melissa Borrelli
- Division of Paediatrics, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Francesca Santamaria
- Division of Paediatrics, Department of Translational Medical Sciences, Federico II University, Naples, Italy
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Bukamur HS, Alkhankan E, Mezughi HM, Munn NJ, Shweihat YR. The role and safety of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and management of infected bronchogenic mediastinal cysts in adults. Respir Med Case Rep 2018; 24:46-49. [PMID: 29977757 PMCID: PMC6010617 DOI: 10.1016/j.rmcr.2018.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/02/2018] [Accepted: 04/03/2018] [Indexed: 11/26/2022] Open
Abstract
Bronchogenic and other duplication cysts are congenital abnormalities that can present at any age including adulthood years. They are usually asymptomatic and discovered incidentally on radiological imaging of the chest. They are commonly treated by surgical resection. Recently, endobronchial ultrasound has been used to assist in diagnosis when radiologic imaging is not definitive. Endobronchial ultrasound has been used rarely to drain infected cysts, a rare complication of the bronchogenic cyst. We present a unique case of an infected large bronchogenic cyst treated with endobronchial ultrasound drainage combined with conservative medical therapy. We also review the scarce available literature describing such an approach and its potential complications and add recommendations based on our experience in managing these anomalies.
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Affiliation(s)
- Hazim S Bukamur
- Department of Pulmonary and Critical Care Medicine, Marshall University, Joan C. Edwards School of Medicine and the Huntington Veterans Administration Medical Center, Huntington, WV 25701, USA
| | - Emad Alkhankan
- Department of Pulmonary and Critical Care Medicine, Marshall University, Joan C. Edwards School of Medicine and the Huntington Veterans Administration Medical Center, Huntington, WV 25701, USA
| | - Haitem M Mezughi
- Department of Internal Medicine, Marshall University, Joan C. Edwards School of Medicine, Huntington, WV 25701, USA
| | - Nancy J Munn
- Department of Pulmonary and Critical Care Medicine, Marshall University, Joan C. Edwards School of Medicine and the Huntington Veterans Administration Medical Center, Huntington, WV 25701, USA
| | - Yousef R Shweihat
- Department of Pulmonary and Critical Care Medicine, Marshall University, Joan C. Edwards School of Medicine and the Huntington Veterans Administration Medical Center, Huntington, WV 25701, USA
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Ulaş AB, Aydın Y, Eroğlu A. Comparison of video-assisted thoracoscopic surgery and thoracotomy in the treatment of mediastinal cysts. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2018; 26:265-271. [PMID: 32082744 PMCID: PMC7024113 DOI: 10.5606/tgkdc.dergisi.2018.15233] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 10/26/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND This study aims to compare the results of videoassisted thoracoscopic surgery and thoracotomy in the treatment of mediastinal cystic lesions. METHODS Sixty patients (28 males, 32 females; mean age 36.1±19.4 years; range, 2 days to 82 years) who were performed thoracotomy or video-assisted thoracoscopic surgery for mediastinal cyst treatment in our clinic between January 1997 and December 2016 were retrospectively evaluated. Chest radiography and thorax computed tomography were used in all participants for diagnosis. Magnetic resonance imaging was used additionally in 23 participants. RESULTS Of the patients, mediastinal cysts were localized in anteriorsuperior mediastinum in 19 (31.7%), middle mediastinum in 19 (31.7%) and posterior mediastinum in 22 (36.6%). Histopathologically, 17 bronchogenic cysts, 15 hydatid cysts, 10 pericardial cysts, seven cystic teratomas, four enteric cysts, four thymic cysts, two lymphangiomas and one thoracic duct cyst were identified. While thoracotomy was performed in 34 patients (56.7%), video-assisted thoracoscopic surgery was performed in 26 patients (43.3%). Mean duration of thoracotomies and video-assisted thoracoscopic surgeries was 123.6±24.7 minutes and 87.4±17.6 minutes, respectively (p<0.01). Mean duration of hospital stay was 8.2±4.3 days after thoracotomy and 4.3±1.2 days after video-assisted thoracoscopic surgery (p<0.01). While postoperative complications developed in four patients (two pneumothoraxes, one pleural effusion, one chylothorax), no mortality was observed in any of them. CONCLUSION Main treatment method for mediastinal cysts is surgery. Thoracoscopic approach significantly reduces patient's duration of surgical procedure and postoperative duration of hospital stay. We believe that minimally invasive approaches will be administered more frequently compared to open surgeries for mediastinal cysts in the near future.
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Affiliation(s)
- Ali Bilal Ulaş
- Department of Thoracic Surgery, Medicine Faculty of Atatürk University, Erzurum, Turkey
| | - Yener Aydın
- Department of Thoracic Surgery, Medicine Faculty of Atatürk University, Erzurum, Turkey
| | - Atilla Eroğlu
- Department of Thoracic Surgery, Medicine Faculty of Atatürk University, Erzurum, Turkey
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Sloan KA, Lakhoo K. Mediastinal Epidermoid Cyst in a 5-Year-Old Girl. European J Pediatr Surg Rep 2018; 6:e24-e26. [PMID: 29577001 PMCID: PMC5864518 DOI: 10.1055/s-0037-1621707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 11/26/2017] [Indexed: 11/13/2022] Open
Abstract
A 5-year-old girl was referred to our unit with an incidental finding of a lesion on the right hemithorax situated within the right atrial shadow. Computed tomography thorax showed a well-defined soft tissue lesion felt to be consistent with a bronchogenic cyst. The lesion was located in the posterior mediastinum, adherent to the diaphragm and inferior vena cava, but did not extend within the wall of the esophagus. It was entirely excised via video-assisted thoracoscopy converted to open thoracotomy. Histopathology confirmed an encapsulated nodular tissue measuring 2.5 × 2.5 × 2 cm lined by squamous type epithelium. Chronic inflammatory cells and foreign body giant cell reaction were found in the cyst wall. The appearances were that of a benign epidermoid cyst.
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Affiliation(s)
- Keren A Sloan
- Department of Paediatric Surgery, John Radcliffe Hospital, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Kokila Lakhoo
- Department of Paediatric Surgery, John Radcliffe Hospital, Oxford, United Kingdom of Great Britain and Northern Ireland
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44
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Cheng L, Huang A, Jiang K, Xing S, Wang J, Nie J. Urgent Surgical Approach to Mediastinal Cyst Causing Life-Threatening Tracheal Obstruction. Ann Thorac Surg 2018; 105:e125-e128. [PMID: 29455825 DOI: 10.1016/j.athoracsur.2017.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 10/06/2017] [Accepted: 10/10/2017] [Indexed: 10/18/2022]
Abstract
This case describes an urgent surgical approach to a patient with symptoms of rapid progressive respiratory compromise resulting from a massive mediastinal cyst. To relieve tracheal compression, ultrasound-guided percutaneous fine-needle aspiration was performed as an urgent procedure, which immediately improved the patient's airway obstruction and facilitated double-lumen endotracheal intubation. Methylene blue was injected into the cyst through the puncturing needle and accurately marked the margins of the cyst. The cyst was completely resected under thoracoscopy. The signs and symptoms of airway obstruction resolved after the operation, with no recurrence observed during the 1-year follow-up.
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Affiliation(s)
- Lin Cheng
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ai Huang
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ke Jiang
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shijie Xing
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianjun Wang
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jun Nie
- Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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45
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Chhabria BA, Agarwal R, Garg M, Gupta N, Bal A, Dhooria S, Sehgal IS. A rare cause of airway obstruction: Mediastinal cyst secondarily infected with Mycobacterium tuberculosis. Lung India 2018; 35:421-424. [PMID: 30168463 PMCID: PMC6120315 DOI: 10.4103/lungindia.lungindia_445_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Mediastinal cysts are mostly congenital, but rarely, infections and malignancies can cause cystic degeneration of enlarged mediastinal lymph nodes. Diagnosis is challenging as the presenting symptoms are nonspecific. Surgical resection is the reference modality both for diagnosis and management. Secondary infection of mediastinal bronchogenic cyst with Mycobacterium tuberculosis is rare. Herein, we describe a young male who was managed as bronchial asthma with inhalational bronchodilators and glucocorticoids. Computed tomography revealed a cystic lesion in the subcarinal region. Endobronchial ultrasound-guided transbronchial needle aspiration was done to perform diagnostic and therapeutic aspiration of the cyst that showed infection with M. tuberculosis. A subsequent surgical resection confirmed the cystic lesion to be a bronchogenic cyst.
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Affiliation(s)
- Bharath A Chhabria
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mandeep Garg
- Department of Radio Diagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nalini Gupta
- Department of Cytopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amanjit Bal
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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46
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Salam A, Mubashir M, Mubashir H, Fatimi SH. Giant retrocardiac foregut duplication cyst presenting with left atrial compression and palpitations. BMJ Case Rep 2017; 2017:bcr-2017-222427. [PMID: 29237664 DOI: 10.1136/bcr-2017-222427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 35-year-old man presented with a 3-month history of palpitations and shortness of breath. An ECG showed premature atrial contractions and episodes of supraventricular tachycardia. A subsequent echocardiogram showed a retrocardiac cystic mass that was compressing the left atrium. A CT scan confirmed these findings by showing a large left-sided posterior mediastinal cyst compressing the left atrium and pulmonary veins. The cyst was successfully excised from the retrocardiac position via left thoracotomy after which there was complete resolution of the palpitations. Histopathology showed it to be a mediastinal cyst, most likely a foregut duplication of the enterogenic variant. This is an extremely unusual case of foregut duplication cyst presenting with compression of the left atrium and pulmonary veins leading to atrial arrhythmias.
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Affiliation(s)
- Abdus Salam
- Medical College, Aga Khan University, Karachi, Pakistan
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47
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Wang X, Chen K, Li X, Li Y, Yang F, Li J, Jiang G, Liu J, Wang J. Clinical features, diagnosis and thoracoscopic surgical treatment of thymic cysts. J Thorac Dis 2017; 9:5203-5211. [PMID: 29312727 DOI: 10.21037/jtd.2017.10.148] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Thymic cysts are rare benign developmental anomalies and there is no consensus management for thymic cysts. The aim of this study was to disclose the efficacy of perioperative diagnosis for thymic cysts by chest computerized tomography (CT) and to elucidate the surgical procedure by video-assisted thoracic surgery (VATS) in the management of thymic cysts. Methods We retrospectively reviewed 108 consecutive thymic cyst patients who underwent VATS at our institution between April 2001 and August 2015. All patients received chest CT preoperatively and underwent VATS treatment. Clinical characteristics, imaging features and surgical exploration were taken into consideration to determine the surgical extent. Results Multivariate logistic regression analysis showed that a diameter ≤3 cm [risk ratio (RR) =4.525; 95% confidence interval (CI), 1.027-20.000; P=0.046] and an unenhanced CT value >20 Hounsfield unit (Hu) (RR =7.043; 95% CI, 1.750-28.345; P=0.006) were independent factors of incorrect diagnosis of chest CT. Three different surgical procedures were performed, which included thymectomy (n=49), cyst resection and partial thymectomy (n=46), and extended thymectomy (n=13). No serious postoperative complications were observed. The median follow-up-time was 60.6 months (range, 12.0-168.0 months) with no late complications or recurrences. Conclusions A diameter ≤3 cm and an unenhanced CT value >20 Hu were independent factors of incorrect diagnosis of chest CT. VATS is a reliable approach for the surgical resection of thymic cysts. We think that local resection is adequate for simple thymic cysts. However, thymectomy is necessary when there is suspicion of a thymoma or multilocular thymic cyst, and radical thymectomy is advisable for patients with autoimmune diseases.
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Affiliation(s)
- Xun Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing 100044, China
| | - Kezhong Chen
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing 100044, China
| | - Xiao Li
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing 100044, China
| | - Yun Li
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing 100044, China
| | - Fan Yang
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing 100044, China
| | - Jianfeng Li
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing 100044, China
| | - Guanchao Jiang
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing 100044, China
| | - Jun Liu
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing 100044, China
| | - Jun Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Peking University, Beijing 100044, China
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Abstract
Mediastinal masses are usually assessed by computer tomography (CT) and magnetic resonance imaging (MRI). Transthoracic ultrasonography (TUS) can also provide useful information concerning prevascular and posterior mediastinal masses abutting the thoracic wall, but is underused for mediastinal pathology. Moreover, it provides a valuable and safe method for guiding interventional procedures in those areas, even in cases when other approaches are difficult or impossible. Considering TUS a very useful imagistic method for diagnosing mediastinal masses, we present a pictorial essay of various mediastinal diseases which can be assessed by this method.
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Affiliation(s)
- Romeo Ioan Chira
- 1st Medical Clinic, Gastroenterology Department
- Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Alexandra Chira
- 2nd Medical Clinic, Emergency Clinical County Hospital Cluj
- Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Petru Adrian Mircea
- 1st Medical Clinic, Gastroenterology Department
- Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania
| | - Simona Valean
- 1st Medical Clinic, Gastroenterology Department
- Department of Internal Medicine, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania
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Lee JE, Cha YK, Kim JS, Choi JH, Han KM. Müllerian Cyst in Posterior Mediastinum in a Young Woman. Balkan Med J 2017; 35:216-218. [PMID: 29180343 PMCID: PMC5863266 DOI: 10.4274/balkanmedj.2017.0896] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Jung Eun Lee
- Department of Radiology, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Yoon Ki Cha
- Department of Radiology, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Jeung Sook Kim
- Department of Radiology, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Jin-Ho Choi
- Department of Thoracic and Cardiovascular Surgery, Dongguk University Ilsan Hospital, Goyang, South Korea
| | - Kang Min Han
- Department of Pathology, Dongguk University Ilsan Hospital, Goyang, South Korea
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50
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Caterino U, Amore D, Cicalese M, Curcio C. Anterior bronchogenic mediastinal cyst as priority procedure for robotic thoracic surgery. J Thorac Dis 2017; 9:E674-E676. [PMID: 28932583 DOI: 10.21037/jtd.2017.07.39] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We report a case of anterior bronchogenic mediastinal cyst (ABMC) in old age patient underwent Robotic Thoracic Surgery (da Vinci Surgical System). Video-assisted thoracoscopic surgery (VATS) represents the routine approach in posterior bronchogenic mediastinal cyst, but some limitation for resection of mediastinal mass located in the anterior mediastinum has been reported. The introduction of da Vinci surgical system has overcome the surgical limits of VATS as two dimensional vision (2D) and the use of long rigid instruments with poor maneuverability in case of fine dissection.
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Affiliation(s)
| | - Dario Amore
- Thoracic Surgery Unit, V. Monaldi Hospital, Naples, Italy
| | | | - Carlo Curcio
- Thoracic Surgery Unit, V. Monaldi Hospital, Naples, Italy
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