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The Annals of Thoracic Surgery May 2022Ectopic pancreas within the anterior mediastinum is a rare congenital anomaly. We present a case of a solid anterior mediastinal mass that presented with hemoptysis and...
Ectopic pancreas within the anterior mediastinum is a rare congenital anomaly. We present a case of a solid anterior mediastinal mass that presented with hemoptysis and ground glass parenchymal changes in the right upper lobe. Robotic surgical resection was completed, and final pathology was consistent with benign pancreatic tissue. The patient fully recovered with no recurrence of hemoptysis. Ectopic pancreas, although uncommon, should be included in the differential for solid and cystic anterior mediastinal masses; surgical resection is often curative and effectively manages symptoms.
Topics: Choristoma; Hemoptysis; Humans; Mediastinal Diseases; Mediastinum; Pancreas
PubMed: 34329599
DOI: 10.1016/j.athoracsur.2021.07.012 -
Georgian Medical News May 2015165 percutaneous biopsies of anterior, middle and posterior mediastinum lesions were performed to 156 patients. Procedure was guided by US in 40 cases, by CT - in 125...
165 percutaneous biopsies of anterior, middle and posterior mediastinum lesions were performed to 156 patients. Procedure was guided by US in 40 cases, by CT - in 125 cases. Hydrodissection was used in 5 cases, artificial pneumothorax - in 3 cases in order to avoid transpulmonary needle pass. Post-biopsy CT scan was performed and patients observed for any complications. Adequate tissue for histological diagnosis was obtained in 156 (94.5%) cases at the first attempt; in 9 (5.5%) cases the repeated procedure was needed. No major complications were detected after biopsy procedures; minor complications (pneumothorax, hemothorax and hemophtysis) were detected in 23 (13.9%) cases. No complications were detected after US guided procedures; In 17 (10.3% of all complications) cases pneumothorax, in 4 (2.4%) cases - hemothorax and in 2 (1.2%) cases hemophtisis was detected on CT guided procedures. All hemothorax and hemophtisis and 10 pneumothorax cases happened to be self-limited; in 3 pneumothorax cases aspiration and in 4 cases - pleural drainage was needed. Percutaneous image-guided core biopsy of mediastinal lesions is an accurate and safe procedure, which enables to get the tissue material from all mediastinum compartments. Ultrasound is the most efficient for biopsy guidance, if the target is adequately imaged by it; the advantages of US guidance are: a) possibility of real-time needle movement control b) possibility of real-time blood flow imaging b) noninvasiveness c) cost-effectiveness d) possibility to perform the biopsy at the bedside, in a semiupright position; so, ultrasound is a "Gold Standard" for procedure guidance if the 'target" can be adequately imaged by this technique. If US guidance is impossible biopsy should be performed under CT guidance. Hydrodissection and artificial pneumothorax enables to avoid the lung tissue penetration related complications. Pneumothorax was associated with multiple Needle passes and larger diameter needle use. The safety and biopsy procedure success high rate proves the use of IGMPCB as a first choice procedure when the mediastinal mass morphology is needed.
Topics: Humans; Image-Guided Biopsy; Lung; Mediastinum; Pneumothorax; Tomography, X-Ray Computed
PubMed: 26042444
DOI: No ID Found -
BMJ Case Reports Jan 2013Our case report describes an unusual cause of a mediastinal mass. The patient is a current smoker with a background of neurofibromatosis (NF) type 1 who presented with a...
Our case report describes an unusual cause of a mediastinal mass. The patient is a current smoker with a background of neurofibromatosis (NF) type 1 who presented with a right apical mass. Initial investigations suggested a probable malignant cause. The final diagnosis was one of a haematoma from a ruptured thyrocervical aneurysm. The association between neurofibromatosis and vascular aneurysms is an often unrecognised but documented phenomenon. We would like to raise an awareness of this infrequent presentation, as it is associated with a high mortality and may be prevented by early diagnosis.
Topics: Adult; Aneurysm; Hematoma; Humans; Magnetic Resonance Imaging; Male; Mediastinum
PubMed: 23299694
DOI: 10.1136/bcr-2012-007978 -
Pediatric Radiology Sep 2022Mediastinal masses are commonly identified in the pediatric population with cross-sectional imaging central to the diagnosis and management of these lesions. With... (Review)
Review
Mediastinal masses are commonly identified in the pediatric population with cross-sectional imaging central to the diagnosis and management of these lesions. With greater anatomical definition afforded by cross-sectional imaging, classification of mediastinal masses into the traditional anterior, middle and posterior mediastinal compartments - as based on the lateral chest radiograph - has diminishing application. In recent years, the International Thymic Malignancy Interest Group (ITMIG) classification system of mediastinal masses, which is cross-sectionally based, has garnered acceptance by multiple thoracic societies and been applied in adults. Therefore, there is a need for pediatric radiologists to clearly understand the ITMIG classification system and how it applies to the pediatric population. The main purpose of this article is to provide an updated review of common pediatric mediastinal masses and mediastinal manifestations of systemic disease processes in the pediatric population based on the new ITMIG classification system.
Topics: Adult; Child; Humans; Mediastinal Neoplasms; Mediastinum; Public Opinion; Thymus Neoplasms; Tomography, X-Ray Computed
PubMed: 35476071
DOI: 10.1007/s00247-022-05361-3 -
Journal of Pediatric Orthopedics 2020Acute posterior sternoclavicular dislocations (APSCD) are rare injuries that historically have prompted concern for injury to the great vessels and other mediastinal...
BACKGROUND
Acute posterior sternoclavicular dislocations (APSCD) are rare injuries that historically have prompted concern for injury to the great vessels and other mediastinal structures from initial trauma or subsequent treatment, resulting in the recommendation that a thoracic or vascular surgeon be present or available during operative treatment. The objectives of the study were to characterize the demographic, clinical, and radiographic characteristics of a large series of APSCDs in skeletally immature patients and to describe the rate and nature of any vascular or mediastinal complications that occurred during treatment.
METHODS
Following Institutional Review Board approval, records of consecutive patients under 25 years of age treated for APSCD were collected from each of 6 participating centers. Only acute injuries (sustained fewer than 10 days before presentation) were included. Patient demographics, injury mechanism, associated mediastinal injuries, and need for thoracic/vascular surgery were recorded. Mediastinal structures injured or compressed by mass effect were specifically characterized by review of preoperative computed tomography imaging.
RESULTS
Review identified 125 patients with a mean age of 14.7 years; 88% were male. APSCD most commonly resulted from a sporting injury (74%) followed by falls from standing height (10%) and high-energy motor vehicle trauma (10%). The most common finding on cross-sectional imaging was compression without laceration of the ipsilateral brachiocephalic vein (50%). Eleven patients had successful closed reduction, and 114 (90%) had open reduction and internal fixation, with 25 failed or unstable closed reductions preceding open treatment. There were no vascular or mediastinal injuries during reduction or fixation that required intervention.
CONCLUSIONS
In this multicenter series of 125 APSCDs no injuries to the great vessels/mediastinal structures requiring intervention were identified. Although more than half of patients had evidence of extrinsic vascular compression at the time of injury, careful open reduction of acute injuries can be safely performed. Although vascular injuries following APSCD seem to be quite rare, vascular complications can be catastrophic. Treating providers should consider these data and their own institutional resources to maximize patient safety during the treatment of APSCD.
LEVEL OF EVIDENCE
Level III-therapeutic case control study.
Topics: Accidental Falls; Adolescent; Child; Child, Preschool; Female; Fracture Fixation, Internal; Humans; Joint Dislocations; Male; Mediastinum; Retrospective Studies; Sternoclavicular Joint; Vascular System Injuries; Young Adult
PubMed: 32804865
DOI: 10.1097/BPO.0000000000001649 -
Chest Nov 1980A previously healthy man with lytic bone lesion of the left talus was found to have a large middle mediastinal mass on routine admission chest roentgenogram. A large...
A previously healthy man with lytic bone lesion of the left talus was found to have a large middle mediastinal mass on routine admission chest roentgenogram. A large amyloid tumor of the mediastinum, representing the sole intrathoracic manifestation of primary amyloidosis, was resected. This presentation of intrathoracic amyloidosis has not previously been reported.
Topics: Amyloid; Amyloidosis; Bone Diseases; Bone Transplantation; Humans; Male; Mediastinal Neoplasms; Mediastinum; Middle Aged; Radiography; Talus
PubMed: 7000453
DOI: 10.1378/chest.78.5.786 -
Revista Espanola de Enfermedades... Nov 2022A 35-year-old male with a history of recurrent pleuritic chest pain was referred for evaluation of a mediastinal mass detected on CT. MRI showed a 10.5 x 7 x 3 cm lesion...
A 35-year-old male with a history of recurrent pleuritic chest pain was referred for evaluation of a mediastinal mass detected on CT. MRI showed a 10.5 x 7 x 3 cm lesion in the posterior mediastinum. EUS revealed a multicystic lesion with thin septa and clear anechoic content that extended from the lower posterior mediastinum to the upper retroperitoneum. EUS-FNA was performed using a 22-gauge needle with aspiration of a serosanguineous fluid. Fluid analysis showed low values of amylase, triglycerides, CEA, and CA19-9. Cytology tests identified small mature lymphocytes without malignancy.
Topics: Male; Humans; Adult; Endosonography; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Mediastinum; Mediastinal Diseases; Needles; Surgical Instruments
PubMed: 35187944
DOI: 10.17235/reed.2022.8697/2022 -
Respiration; International Review of... 2010
Topics: Aged, 80 and over; Aneurysm, Infected; Diagnostic Errors; Ductus Arteriosus; Humans; Iatrogenic Disease; Lung; Lung Diseases; Male; Mediastinitis; Radiography; Superinfection; Thrombosis; Vascular Malformations
PubMed: 20501983
DOI: 10.1159/000315143 -
Medicine Aug 2018Based on imaging and biopsy results, surgical removal of mediastinal nodular hyperplasia (MNH) may be unnecessary, and mediastomy may be avoidable.
RATIONALE
Based on imaging and biopsy results, surgical removal of mediastinal nodular hyperplasia (MNH) may be unnecessary, and mediastomy may be avoidable.
PATIENT CONCERNS
We report three cases of nodular hyperplasia presenting as a mediastinal mass on imaging studies during a health check-up or for the evaluation of known abscess in the right masticator and submandibular spaces.
INTERVENTIONS
In the first two cases, surgical excision was performed, and in the third case, US-guided core needle biopsy was performed.
DIAGNOSES
Histopathological examination revealed MNH in the first two cases, and histologic examination suggested MNH.
OUTCOMES
In the first two cases, there were no associated complications after successful surgical removal. In the third case, surgery was not performed because of old age and no associated symptoms.
LESSONS
MNH may mimic mediastinal tumors on imaging studies. Accordingly, awareness of imaging features, interval changes, associated symptoms, and biopsy results may be necessary for the appropriate management of MNH.
Topics: Aged; Aged, 80 and over; Diagnosis, Differential; Female; Humans; Hyperplasia; Mediastinal Neoplasms; Mediastinum; Middle Aged; Thyroid Nodule
PubMed: 30142857
DOI: 10.1097/MD.0000000000012050 -
Canadian Respiratory Journal 2000The authors describe a 43-year-old patient who had a mediastinal mass that became infected after a transbronchial needle aspirate biopsy. A paraspinal, extrapleural...
The authors describe a 43-year-old patient who had a mediastinal mass that became infected after a transbronchial needle aspirate biopsy. A paraspinal, extrapleural window with a saline-lidocaine mixture was created that allowed the placement of a percutaneous drainage catheter into the infected lesion. This procedure resulted in an excellent clinical outcome, and obviated the need for a thoracotomy and more invasive surgical management.
Topics: Adult; Drainage; Humans; Male; Mediastinal Cyst; Mediastinum; Tomography, X-Ray Computed
PubMed: 10859405
DOI: 10.1155/2000/369023