-
Acta Chirurgica Belgica 2012Mediastinal cysts are rare, forming 12-18% of all primary mediastinal tumors. The purpose of this study is to evaluate type, clinical properties, treatment modalities,...
AIM
Mediastinal cysts are rare, forming 12-18% of all primary mediastinal tumors. The purpose of this study is to evaluate type, clinical properties, treatment modalities, and results of mediastinal cystic neoplasm in the light of available literature.
PATIENTS AND METHODS
We retrospectively investigated 29 patients who were diagnosed and surgically treated for mediastinal cysts in our clinic between January 1996 and May 2011.
RESULTS
Sixteen (55.2%) patients were male and 13 (44.8%) were female. The average age of the patients was 36.5 +/- 22.1 (17-77 years old). The mediastinal cysts comprised 11 (37.9%) bronchogenic cysts; seven (24.1%) hydatid cysts; four (13.8%) benign cystic teratomas; three (10.3%) pericardial cysts; one (5.3%) thymic cyst; one (5.3%) cyst of the thoracic duct; one (5.3%) enteric cyst; and one (5.3%) lymphangioma. Approach methods were thoracotomy in 18 (62.1%) cases; video-assisted thoracoscopicsurgery (VATS) in seven (24.1%) cases; median sternotomy in three (10.3%) cases; and anterior mediastinotomy in one case. Postoperative observations during the follow-up period showed chylothorax in one patient; pleural effusion in one patient; and the recurrence of a bronchogenic cyst in one patient five years after the operation. Postoperative mortality did not occur in any case. The average postoperative hospitalization period was 7.3 days (2-14 days).
CONCLUSION
A surgical approach to mediastinal cysts offers histological analysis, pathological diagnosis, curative treatment, and prevention from complications.
Topics: Adolescent; Adult; Aged; Bronchogenic Cyst; Echinococcosis, Pulmonary; Female; Humans; Length of Stay; Magnetic Resonance Imaging; Male; Mediastinal Cyst; Middle Aged; Thoracic Surgery, Video-Assisted; Thoracotomy; Tomography, X-Ray Computed; Young Adult
PubMed: 23008992
DOI: No ID Found -
Seminars in Cardiothoracic and Vascular... Dec 2012The perioperative management of the patient with an anterior mediastinal mass (AMM) is viewed as one of the more challenging anesthetic endeavors. Diligent preoperative...
The perioperative management of the patient with an anterior mediastinal mass (AMM) is viewed as one of the more challenging anesthetic endeavors. Diligent preoperative planning is essential and often involves imaging studies using multiple modalities, pulmonary function assessment, and minimally invasive biopsy for tissue diagnosis prior to arriving in the operating room. Anesthetic induction, often without major risks in most patients, can be catastrophic in AMM patients, with possible complications that include complete airway obstruction and cardiovascular collapse. The authors present the case of a biopsy via anterior mediastinotomy under monitored anesthesia care (MAC)/sedation in a 39-year-old man, who presented with a large AMM causing significant right heart compression without tracheobronchial involvement. This procedure was followed by definitive mass resection approximately 6 weeks later. This review will explore the following: (1) the use of MAC/sedation for AMM biopsy, (2) methods of safely securing the airway in patients undergoing definitive mass resection via median sternotomy, (3) current opinions regarding the need for preoperative pulmonary function testing in these patients, (4) current opinions regarding the need for and timing of cardiopulmonary bypass in these cases, (5) the use of intraoperative transesophageal echocardiography during resection, and (6) the characteristics of mediastinal germ-cell tumors with sarcomatous conversion. Though multiple anesthetic methods have been proposed for the management of patients undergoing tissue biopsy and resection of an AMM, this case report presents 2 successful anesthetic options for 2 distinct surgical procedures. In every instance, the anesthetic management options must be tailored to the unique physiological needs of the patient presenting for surgery.
Topics: Adult; Anesthesia; Biopsy; Echocardiography, Transesophageal; Humans; Magnetic Resonance Imaging; Male; Mediastinal Neoplasms; Mediastinum; Neoplasms, Germ Cell and Embryonal
PubMed: 22891051
DOI: 10.1177/1089253212454336 -
Asian Cardiovascular & Thoracic Annals Jun 2012We studied 13 patients with mediastinal abscesses caused by oropharyngeal infections, who presented between April 2007 and June 2011. All patients were operated on after...
We studied 13 patients with mediastinal abscesses caused by oropharyngeal infections, who presented between April 2007 and June 2011. All patients were operated on after maxillofacial and ear, nose and throat surgeons had treated the primary source and drained all collections in the neck. Thoracic surgery was performed in the same session. Anterior mediastinal collections were drained via a small mediastinotomy. Posterior collections were approached via a thoracotomy. Chest computed tomography was essential to delineate the extent of disease. A thoracotomy approach was used in 7 patients; 2 of them required an anterior mediastinotomy on the opposite side. The others had an anterior mediastinotomy which was bilateral in 2 cases. After repeat computed tomography, 5 patients were operated on for suspected new loculations; tissue edema had caused false imaging in 3 of them. There was no mortality. Early after eradication of the source and pathways to the mediastinum, gravity drainage of mediastinal abscesses, and good antibiotic cover, with repeat computed tomography after 3 days, was an effective approach in this highly fatal disease.
Topics: Abscess; Adolescent; Adult; Anti-Bacterial Agents; Child; Drainage; Female; Humans; Jaw Diseases; Male; Mandibular Fractures; Mediastinitis; Mediastinum; Middle Aged; Peritonsillar Abscess; Predictive Value of Tests; Reoperation; South Africa; Thoracic Surgical Procedures; Thoracotomy; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Young Adult
PubMed: 22718719
DOI: 10.1177/0218492311434088 -
Zentralblatt Fur Chirurgie Jun 2012Today several methods for invasive mediastinal staging of lung cancer are available. Whereas mediastinoscopy and anterior mediastinotomy had been the gold standard in... (Comparative Study)
Comparative Study Review
Today several methods for invasive mediastinal staging of lung cancer are available. Whereas mediastinoscopy and anterior mediastinotomy had been the gold standard in every situation several years ago, today EBUS-TBNA has been developed as an alternative to mediastinoscopy concerning the status of lymph node positions 2 L / R, 4 L / R and 7. Actually mediastinoscopy is accepted as the gold standard only in special situations such as negative cytology of suspicious lymph nodes after EBUS-TBNA and mediastinal evaluation after neoadjuvant treatment.
Topics: Combined Modality Therapy; Humans; Lung Neoplasms; Lymph Node Excision; Mediastinoscopy; Neoadjuvant Therapy; Neoplasm Invasiveness; Neoplasm Staging; Prognosis; Survival Rate
PubMed: 22711324
DOI: 10.1055/s-0031-1283950 -
Revue Des Maladies Respiratoires Feb 2012The discovery of an anterior mediastinal mass requires careful management with specific consideration of the pathology. More than 50% of all mediastinal masses seen in... (Review)
Review
The discovery of an anterior mediastinal mass requires careful management with specific consideration of the pathology. More than 50% of all mediastinal masses seen in adults are in the anterior mediastinum. The most frequent diagnoses are thymoma, lymphoma, teratoma and benign thyroid tumours. 60% of cases are malignant. Often the clinical and radiological findings do not allow a definitive diagnosis and a histological diagnosis is often required to select the optimal treatment modality. The choice of biopsy technique depends on the localization of the lesion, clinical factors, and the availability of special techniques and equipment. Biopsy may be obtained by trans-thoracic puncture under computed tomography or ultrasound guidance, or by a surgical approach (mediastinotomy or thoracoscopy).
Topics: Adult; Biomarkers, Tumor; Biopsy, Needle; Carcinoid Tumor; Carcinoma; Diagnosis, Differential; Granuloma; Humans; Lipoma; Lymphoma; Mediastinal Neoplasms; Mediastinum; Neoplasms, Germ Cell and Embryonal; Thymoma; Thymus Hyperplasia; Thymus Neoplasms; Thyroid Neoplasms
PubMed: 22405109
DOI: 10.1016/j.rmr.2011.11.015 -
Multimedia Manual of Cardiothoracic... Jan 2012Surgical exploration of subaortic and para-aortic lymph nodes has traditionally required the combination of standard cervical mediastinoscopy and left anterior...
Surgical exploration of subaortic and para-aortic lymph nodes has traditionally required the combination of standard cervical mediastinoscopy and left anterior mediastinotomy. Video-assisted thoracoscopic surgery is another technique that allows the exploration of these nodal stations. Extended cervical mediastinoscopy is a useful and safe technique for the assessment of para-aortic and subaortic nodal stations through the same incision of the standard cervical mediastinoscopy.
PubMed: 24414721
DOI: 10.1093/mmcts/mms018 -
Pneumologia (Bucharest, Romania) 2011Management strategies for anterior mediastinal masses (AMMs) depend strongly on the histopathological diagnosis. The manifestations of these masses sometimes are an...
INTRODUCTION
Management strategies for anterior mediastinal masses (AMMs) depend strongly on the histopathological diagnosis. The manifestations of these masses sometimes are an emergency because of large airway or great vessel compression which make general anesthesia challenging and hazardous and many authors have emphasized the dangers of general anesthesia in such patients.
METHODS
This prospective study carried on 23 patients with AMMs and large airway or vessel compression via mini-mediastinotomy under local anesthesia for taking histological biopsy.
RESULTS
. A definite histolopathological diagnosis was made in all cases. Morbidity was seen in one patient with entering the pleural cavity, there was no mortality. Out of 23 patients, 9 patients had already undergone less invasive procedures without definite diagnosis.
CONCLUSIONS
Mini-mediastinotomy under local anesthesia for diagnostic biopsy in AMMs with airway compression is safe, minimally invasive, effective, and is useful in therapeutic decision making for AMMs.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Airway Obstruction; Anesthesia, Local; Anesthetics, Local; Biopsy; Decompression, Surgical; Diagnosis, Differential; Female; Humans; Male; Mediastinal Diseases; Mediastinoscopy; Middle Aged; Prospective Studies; Treatment Outcome
PubMed: 22097436
DOI: No ID Found -
Surgical Oncology Clinics of North... Oct 2011The treatment of non-small cell lung cancer is stage specific. Aggressive staging is associated with improved stage-specific prognosis. Available methods of surgical... (Review)
Review
The treatment of non-small cell lung cancer is stage specific. Aggressive staging is associated with improved stage-specific prognosis. Available methods of surgical staging include scalene node biopsy, mediastinoscopy, anterior mediastinotomy, and thoracoscopy. In this article the various surgical staging methods are described and their respective roles are discussed.
Topics: Carcinoma, Non-Small-Cell Lung; Humans; Lung Neoplasms; Neoplasm Staging
PubMed: 21986266
DOI: 10.1016/j.soc.2011.07.010 -
Interactive Cardiovascular and Thoracic... May 2011A 63-year-old male with a history of cancer, and who had undergone a left pneumonectomy seven years before, presented with deterioration in his general status and recent...
A 63-year-old male with a history of cancer, and who had undergone a left pneumonectomy seven years before, presented with deterioration in his general status and recent dyspnea [stage III (New York Heart Association) NYHA]. Imaging revealed a contralateral mediastinal shift and cardiac compression caused by pneumonectomy cavity enlargement and a retrosternal liquid mass. Late empyema associated with a retrosternal abscess caused by Propionibacterium acnes was diagnosed after thoracoscopy and an anterior mediastinotomy. Surgical treatment included an axillary open-window thoracostomy associated with negative pressure therapy (NPT), followed by a large thoracomyoplasty where part of the latissimus dorsi was harvested, and then guided healing. The chest was closed after eight months. This case is an unusual observation of a late post-pneumonectomy empyema with Propionibacterium acnes presenting like recurring cancer, but that was treated effectively using traditional (Clagett procedure) and newer (NPT) strategies.
Topics: Abscess; Anti-Bacterial Agents; Biopsy; Drainage; Empyema, Pleural; Humans; Lung Neoplasms; Male; Mediastinal Diseases; Middle Aged; Negative-Pressure Wound Therapy; Pneumonectomy; Propionibacterium acnes; Surgical Flaps; Thoracic Surgery, Video-Assisted; Thoracostomy; Time Factors; Tomography, X-Ray Computed; Treatment Outcome; Wound Healing
PubMed: 21303873
DOI: 10.1510/icvts.2010.262220 -
Journal of the West African College of... Jan 2011Background Cicatricial corrosive oesophageal strictures are usually multiple and occasionally single but the thoracic inlet segment of the oesophagus being a rapid...
UNLABELLED
Background Cicatricial corrosive oesophageal strictures are usually multiple and occasionally single but the thoracic inlet segment of the oesophagus being a rapid transit section is not a common site for isolated strictures. Thoracic inlet located strictures pose two major problems. First, in cases with total obstruction of the oesophagus radiological assessment even with luminal contrast fails to delineate the lower limits and real extent of the lesions. The purported single stricture in such cases becomes merely a sentinel to perhaps a coexisting rosary of strictures more distally. Secondly, the technical difficulty associated with their surgical approach is inherent in the location. The customary anterior low cervical approach is often inadequate thereby making necessary a complementary high left posterolateral thoracotomy, partial anterior mediastinotomy or hiatal approach particularly in situations where the excision of the damaged gullet is advisable.
MATERIALS AND METHODS
In a series of cases treated for cicatricial corrosive stricture those with apparently isolated strictures in the thoracic inlet formed the cohort for this study. Only oesophagoscopy and contrast barium studies were available for the definition of the lesions. Treatment varied from simple resection with end to end anastomosis in seven (7) to more extended resections with gastric or colonic conduits as replacement in four (4) who had extensive cicatricial obliteration of the lumen with tubularization and rigidity of the gullet distal to the apparently solitary stricture. In some of these cases transgastric retrograde bouginage was an option for a reasonable evaluation of the luminal state of the oesophagus distal to the proximal lesion at the thoracic inlet. The reconstructive oesophageal anastomoses were all placed in the neck; none was intrathoracic.
RESULTS
In a series of 316 cases treated for cicatricial corrosive oesophageal strictures, 11 had isolated strictures located in the region of the thoracic inlet. Free swallowing was restored in all cases and where anastomotic leakage occurred they healed spontaneously.
CONCLUSION
Isolated corrosive oesophageal strictures in the region of the thoracic inlet are uncommon and not necessarily single. There are finite diagnostic and operative challenges inherent in their location.
PubMed: 25452943
DOI: No ID Found