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Mediastinum (Hong Kong, China) 2023
PubMed: 37261098
DOI: 10.21037/med-22-30 -
Mediastinum (Hong Kong, China) 2022Mediastinal thymic cysts are a relatively rare pathology. With the expansion of eligible individuals screened with cross-sectional imaging for lung cancer, it is likely... (Review)
Review
BACKGROUND AND OBJECTIVE
Mediastinal thymic cysts are a relatively rare pathology. With the expansion of eligible individuals screened with cross-sectional imaging for lung cancer, it is likely that there will be an increase in the number of individuals presenting with these cysts. Understanding this rare pathology will become more important when this incidental pathology is encountered.
METHODS
Search of PubMed was undertaken using keywords "mediastinal", "mediastinum", "thymic", "thymus", "cyst". Relevant literature was reviewed and selected for this comprehensive narrative review, including case reports, case series, and retrospective reviews.
KEY CONTENT AND FINDINGS
Thymic cysts in the mediastinum can be classified into two broad categories, congenital and inflammatory. Accurate diagnosis by imaging is challenging and the majority of patients are asymptomatic. Literature suggests that the majority of cysts are benign, however an unknown percentage may harbor neoplastic processes and over time can cause significant compressive symptoms. Definitive treatment and diagnosis is surgical, with overall excellent outcomes. The decision to pursue surgical treatment versus surveillance requires a shared decision making approach with patients.
CONCLUSIONS
Given the scarcity of available high quality evidence regarding the management of mediastinal thymic cysts, this review provides practitioners a broad knowledge base to guide patients to make informed decisions.
PubMed: 36582977
DOI: 10.21037/med-22-25 -
Mediastinum (Hong Kong, China) 2022Whether and when surgical intervention is indicated for mediastinal cysts is a matter of some debate. While most mediastinal cysts are found incidentally, the anatomic... (Review)
Review
BACKGROUND AND OBJECTIVE
Whether and when surgical intervention is indicated for mediastinal cysts is a matter of some debate. While most mediastinal cysts are found incidentally, the anatomic location, clinical presentation, and symptoms, as well as the potential for malignancy, are important considerations that inform decisions related to whether to intervene surgically. The objective of this review is to summarize the current literature regarding the criteria for surgical excision of mediastinal cysts and provide a framework for the clinician and surgeon to arrive at a decision regarding the appropriateness of surgical intervention of mediastinal cysts.
METHODS
A review of the published literature in the last 45 years (1977-2022) was conducted through PubMed, MeSh and Google Scholar. We included retrospective reviews, meta-analyses, and case studies published in the English language. A single author identified eligible studies, and those identified were reviewed by the team until consensus was met. Pediatric literature was excluded from this review.
KEY CONTENT AND FINDINGS
The current literature predominantly contains case studies, small retrospective studies, and meta-analyses describing mediastinal cysts. In the anterior mediastinum, multiloculated thymic cysts should be resected to rule out thymic malignancy. Intralesional fat, smooth borders, and a more midline location are features suggestive of a benign process, while asymmetric cystic wall thickening has been associated with malignancy. Both esophageal and bronchogenic cysts should be excised, taking into account the risk of complications (up to a 45% risk) of infection, rupture, or compression, as well as the rare risk of associated malignancy. Simple thymic and small pericardial cysts can be observed and followed with serial radiographic tools and should be resected if they increase in size, compress surrounding structures, or lead the patient to develop symptoms.
CONCLUSIONS
Since mediastinal cysts are rare and often asymptomatic, there are no formal guidelines outlining when surgical intervention should be undertaken. Based on our review of the literature, surgical intervention should be pursued if the patient's symptoms correlate with radiographic findings of a mediastinal cyst, there is compression of the surrounding structures, and concern of malignancy is present.
PubMed: 36582980
DOI: 10.21037/med-22-27 -
Mediastinum (Hong Kong, China) 2022The traditional approach to mediastinal cyst and mass resection has been open via median sternotomy or thoracotomy. With the advent of minimally invasive techniques,... (Review)
Review
The traditional approach to mediastinal cyst and mass resection has been open via median sternotomy or thoracotomy. With the advent of minimally invasive techniques, there have been successful cases completed via video-assisted thoracoscopic (VATS) and robot-assisted thoracoscopic surgery (RATS). Although mediastinal cysts are uncommon, they are a significant and relevant topic in the practice of thoracic surgery. Thus, this clinical practice review aims to summarize and highlight some of the key case series and retrospective studies in order to provide insight on each of the approaches. In addition, there is a brief review of other approaches, such as subxiphoid, and the utility of endobronchial ultrasound in the management of mediastinal cysts. In this review, the identified benefits of VATS and RATS lie largely in quality improvement of the patient experience-decreased length of stay (LOS) and pain-without compromising patient outcomes. However, the open approach remains a viable option, particularly for the management of large cysts or as a bail-out option. When surgeons approach with VATS or RATS and encounter bleeding or difficult dissection planes, it is consistent in the literature that conversion to thoracotomy is the safe next step. Our clinical practice is to attempt VATS or RATS approach for mediastinal cysts when possible. The data used for this review relies heavily on case reports and case series, and thus is the main limitation of this clinical practice review.
PubMed: 36582973
DOI: 10.21037/med-22-20 -
Mediastinum (Hong Kong, China) 2023Bronchogenic cysts represent a rare form of cystic malformation of the respiratory tract. Primarily located in the mediastinum if occurring early in gestation as opposed... (Review)
Review
BACKGROUND AND OBJECTIVE
Bronchogenic cysts represent a rare form of cystic malformation of the respiratory tract. Primarily located in the mediastinum if occurring early in gestation as opposed to the thoracic cavity if arising later in development. However, they can arise from any site along the foregut. They exhibit a variety of clinical and radiologic presentations, representing a diagnostic challenge, especially in areas with endemic hydatid disease. Endoscopic drainage has emerged as a diagnostic and potentially therapeutic option but has been complicated by reports of infection. Surgical excision remains the standard of care allowing for symptomatic resolution and definitive diagnosis via pathologic examination; minimally invasive approaches such as robotic and thoracoscopic approaches aiding treatment. Following complete resection, prognosis is excellent with essentially no recurrence.
METHODS
A review of the available electronic literature was performed from 1975 through 2022, using PubMed and Google Scholar, with an emphasis on more recent series. We included all retrospective series and case reports. A single author identified the studies, and all authors reviewed the selection until there was a consensus on which studies to include.
KEY CONTENT AND FINDINGS
The literature consisted of relatively small series, mixed between adult and pediatric patients, and the consensus remains that all symptomatic lesions should be excised via minimally invasive approach where feasible.
CONCLUSIONS
Surgical excision of symptomatic bronchogenic cysts remains the gold standard, with endoscopic drainage being reserved for diagnosis or as a temporizing measure in clinically unstable patients.
PubMed: 37701638
DOI: 10.21037/med-22-46 -
Journal of the Chinese Medical... Jan 2010The objective of this study was to report our experience in the management of hydatid cysts of the mediastinum.
BACKGROUND
The objective of this study was to report our experience in the management of hydatid cysts of the mediastinum.
METHODS
Among 206 patients who underwent surgery in our department for intrathoracic hydatid cysts between September 2001 and September 2008, 7 patients (3.4%) aged 24 to 49 years (mean, 36.2 years) had mediastinal hydatid cysts. Imaging consisted of chest X-ray and computed tomography. Surgical approach was by posterolateral thoracotomy in all cases.
RESULTS
The cyst was located in the posterior mediastinum in 3 cases (42.8%), in the anterior mediastinum in 2 cases (28.5%) and in the middle mediastinum in 2 cases (28.5%). Two patients had cysts in other thoracic locations (diaphragm, pleural). All cysts were intact. Surgical approach was right thoracotomy in 5 patients (71.4%) and left thoracotomy in 2 patients (28.5%). In 5 cases, a small part of the cyst wall intimately adherent to vital structures was left in place. There were no postoperative complications or mortality.
CONCLUSION
Mediastinal hydatid cyst is an uncommon disease. Because of the surrounding vital structures, the cyst should be removed immediately. Surgical removal remains the treatment of choice for mediastinal echinococcosis, without extensive resection when progression of dissection is impossible or dangerous.
Topics: Adult; Echinococcosis; Female; Humans; Male; Mediastinal Cyst; Middle Aged; Radiography, Thoracic; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 20103484
DOI: 10.1016/s1726-4901(10)70014-9 -
Canadian Medical Association Journal Apr 1963Foregut cysts frequently cause symptoms in the first three decades of life. The symptoms consist of dyspnea, wheezing, cough and sputum, dysphagia, stridor, and those...
Foregut cysts frequently cause symptoms in the first three decades of life. The symptoms consist of dyspnea, wheezing, cough and sputum, dysphagia, stridor, and those associated with right heart strain. Symptoms and the radiological appearance of the uncomplicated cyst mimic mediastinal tumour and mediastinal obstruction. The symptoms and radiological appearance of the ruptured infected cyst simulate those of lung abscess, diaphragmatic hernia, ruptured hydatid cyst, cavitated peripheral carcinoma and pulmonary tuberculosis. In this series the differentiation from other cysts was made thus: with intralobar sequestration, a systemic arterial blood supply was demonstrated; with hydatid cyst, there was a positive intradermal skin test and (radiologically) following rupture, the appearance of a pericystic pneumatocele followed by the water-lily sign was diagnostic; with emphysematous cysts, the signs of associated bronchitis were present; in the presence of pseudocysts, there was a previous history of lung abscess, staphylococcal infection or tuberculosis. Cysts should be removed when first diagnosed.
Topics: Animals; Bronchitis; Cough; Cysts; Dyspnea; Echinococcosis; Echinococcus; Hernia, Hiatal; Humans; Lung Abscess; Mediastinum; Radiology; Respiratory Sounds; Rupture; Sputum; Tuberculosis, Pulmonary
PubMed: 13974421
DOI: No ID Found -
Prilozi (Makedonska Akademija Na... Sep 2017The authors present a rare case of giant mediastinal cyst which arises from the thymus gland, and goes down in both pleural spaces, especially in the right chest cavity...
The authors present a rare case of giant mediastinal cyst which arises from the thymus gland, and goes down in both pleural spaces, especially in the right chest cavity where a dominant part of the cyst was present. The cyst was full with 2.5 liters of transparent fluid, and compressed surrounding structures - heart and both lungs, especially the right one which was partially collapsed. The patient was a 52 years old woman, without any clinical symptoms. Accidentally, on the screened chest X-ray a shading in the distal third of the right chest was detected. The case was well documented with a CT of the chest, and an indication for surgical treatment was made. The surgery was done successfully in general anesthesia according to the small right anterior thoracotomy from which a giant part of the cyst was mobilized, which was in the right pleural cavity, but, also, the thymus with the origin of the cyst in the anterior and superior mediastinum was completely removed. In the end, a part of the cyst which was in the left pleural cavity was removed.
Topics: Biopsy; Female; Humans; Incidental Findings; Mediastinal Cyst; Middle Aged; Thoracotomy; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 28991774
DOI: 10.1515/prilozi-2017-0032 -
Revue Medicale de Liege Nov 2019Mediastinal hydatid cyst is an exceptional pathology that poses a problem of diagnosis with the other cystic lesions of the mediastinum. Diagnosis is suspected on...
Mediastinal hydatid cyst is an exceptional pathology that poses a problem of diagnosis with the other cystic lesions of the mediastinum. Diagnosis is suspected on ultrasound and CT exams and confirmed by surgical findings and histopathological characteristics.
Topics: Echinococcosis; Humans; Mediastinal Cyst; Mediastinum; Tomography, X-Ray Computed; Ultrasonography
PubMed: 31729842
DOI: No ID Found -
Korean Journal of Radiology Jan 2021Magnetic resonance imaging (MRI) has become a crucial tool for evaluating mediastinal masses considering that several lesions that appear indeterminate on computed... (Review)
Review
Magnetic resonance imaging (MRI) has become a crucial tool for evaluating mediastinal masses considering that several lesions that appear indeterminate on computed tomography and radiography can be differentiated on MRI. Using a three-compartment model to localize the mass and employing a basic knowledge of MRI, radiologists can easily diagnose mediastinal masses. Here, we review the use of MRI in evaluating mediastinal masses and present the images of various mediastinal masses categorized using the International Thymic Malignancy Interest Group's three-compartment classification system. These masses include thymic hyperplasia, thymic cyst, pericardial cyst, thymoma, mediastinal hemangioma, lymphoma, mature teratoma, bronchogenic cyst, esophageal duplication cyst, mediastinal thyroid carcinoma originating from ectopic thyroid tissue, mediastinal liposarcoma, mediastinal pancreatic pseudocyst, neurogenic tumor, meningocele, and plasmacytoma.
Topics: Humans; Image Interpretation, Computer-Assisted; Lymphoma; Magnetic Resonance Imaging; Mediastinal Cyst; Mediastinal Neoplasms; Mediastinum; Societies, Medical; Thymoma; Thymus Hyperplasia
PubMed: 32783412
DOI: 10.3348/kjr.2019.0897