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Mediastinum (Hong Kong, China) 2023Esophageal duplication represents one of the most common types of bronchopulmonary foregut malformations. These rare congenital anomalies occur secondary to... (Review)
Review
Esophageal duplication represents one of the most common types of bronchopulmonary foregut malformations. These rare congenital anomalies occur secondary to embryological aberrations between the 4th and 8th weeks of gestation. In order to be classified as an esophageal cyst a mediastinal cyst must have a close proximity with the esophagus, be lined by alimentary (squamous epithelium) or tracheobronchial mucosa and covered by two smooth muscle layers. These rare anomalies are often asymptomatic during adulthood. However, they can cause symptoms in early childhood, generally during the first 2 years of life. Variations in location, size, presence or absence of heterotopic mucosa, will dictate the clinical presentation. Dysphagia, food impaction, persistent cough and chest pain are common clinical presentations. Imaging studies including esophagram, computed tomography (CT) and magnetic resonance imaging (MRI) can provide key findings to reach the diagnosis. Nonetheless, endoscopic evaluation, particularly endoscopic ultrasound (EUS) is the most valuable tool to determine whether this lesion is cystic versus solid and or if there are abnormal mucosal findings. Needle biopsies are controversial but can help with drainage and to rule out malignant transformation. Therapeutic options include endoluminal drainage. However, more definitive therapies include surgical excision. Open and minimally invasive (laparoscopic and thoracoscopic) techniques have been demonstrated to be safe and effective at completely removing these lesions. Recently, robotic-assisted resections have gained more attention with case reports and series reporting excellent outcomes.
PubMed: 36926292
DOI: 10.21037/med-22-33 -
International Medical Case Reports... 2023Hydatid cyst, which is caused by Echinococcus larvae, is a worldwide zoonotic disease which can affect virtually any organ in the body. Although the liver and lungs are...
Hydatid cyst, which is caused by Echinococcus larvae, is a worldwide zoonotic disease which can affect virtually any organ in the body. Although the liver and lungs are the most commonly affected, it can occur in other parts of the body. Mediastinal hydatid cysts are incredibly rare, but imaging is crucial to diagnose and determine the extent of involvement and complications. In this article, we present a case of posterior Mediastinal hydatid cyst with adjacent chest wall and spinal involvement, diagnosed through chest CT and histopathology.
PubMed: 37333036
DOI: 10.2147/IMCRJ.S416652 -
Advances in Respiratory Medicine 2020Mediastinal cysts are typically of bronchogenic, thymic or neurenteric origin, but may also represent oesophageal duplication. Posterior paravertebral mediastinal... (Review)
Review
Mediastinal cysts are typically of bronchogenic, thymic or neurenteric origin, but may also represent oesophageal duplication. Posterior paravertebral mediastinal Müllerian cysts of undetermined pathogenesis are very rare occurrences. The first case of a ciliated cyst arising in the mediastinum, of probable Müllerian origin, was reported by Hattori in 2005, which gave rise to the name cyst of Hatorri (COH) The number of reported cases in literature of a similar nature have since then increased significantly. One of the main concerns about this pathology is the possibility of malignant transformation of the Müllerian tissue. Over the course of this paper we will discuss the pathogenesis, immunohistochemistry and its role in differential diagnosis as well as optimal treatment of such cysts.
Topics: Cysts; Humans; Mediastinal Cyst; Mullerian Ducts; Treatment Outcome
PubMed: 32383465
DOI: 10.5603/ARM.2020.0089 -
The British Journal of Radiology Dec 2011Imaging of patients with suspected or known pericardial disease remains challenging. Echocardiography is the first-line investigation for pericardial disease but it has... (Review)
Review
Imaging of patients with suspected or known pericardial disease remains challenging. Echocardiography is the first-line investigation for pericardial disease but it has specific limitations in terms of its abilities to visualise the pericardium fully and to identify extracardiac pathology. Cardiac cross-sectional imaging by both MRI and CT has developed significantly and now has an important role in the investigation of pericardial disease. This article examines the appearances of both healthy and diseased pericardium using CT and MRI. The typical imaging findings across a wide range of conditions are illustrated and the roles of CT and MRI are reviewed. The relative merits and weaknesses of each modality are explored and the specific functional techniques that are available are introduced.
Topics: Heart Diseases; Heart Neoplasms; Humans; Magnetic Resonance Imaging; Mediastinal Cyst; Pericardial Effusion; Pericarditis; Pericarditis, Constrictive; Pericardium; Tomography, X-Ray Computed
PubMed: 22723538
DOI: 10.1259/bjr/16168253 -
Lung India : Official Organ of Indian... Apr 2010The presentation of the bronchogenic cyst is variable, making pre-operative diagnosis difficult. Majority of them are either asymptomatic or discovered incidentally. The...
The presentation of the bronchogenic cyst is variable, making pre-operative diagnosis difficult. Majority of them are either asymptomatic or discovered incidentally. The most common presenting symptoms are cough, fever and dyspnea. We discuss the case of a large bronchogenic cyst in the posterior mediastinum causing oesophageal compression and impinging on the left atrium. The patient presented with dysphagia and back pain and was extensively investigated by various physicians before being diagnosed as having bronchogenic cyst. We concluded that the backache was due to stretching of nerves in the parietal pleura. This case demonstrates the need for detailed investigations prior to treatment of patients with such symptom complex as a bronchogenic cyst may be the cause of such symptoms.
PubMed: 20616941
DOI: 10.4103/0970-2113.63612 -
Medicine May 2021Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is less commonly used in nonmalignant diseases. In particular, its application in...
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.
Topics: Adult; Anti-Bacterial Agents; Bronchoscopy; Combined Modality Therapy; Drainage; Drug Therapy, Combination; Endosonography; Humans; Incidental Findings; Male; Mediastinal Cyst; Mediastinitis; Pleurisy; Pneumonia; Surgical Wound Infection; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 34011084
DOI: 10.1097/MD.0000000000025973 -
Surgical Case Reports Oct 2020Intrathoracic mesothelial cysts are congenital lesions induced by the abnormal development of the pericardial coelom. There have been a few reports of giant mesothelial...
BACKGROUND
Intrathoracic mesothelial cysts are congenital lesions induced by the abnormal development of the pericardial coelom. There have been a few reports of giant mesothelial cyst of the superior mediastinum, but the preferred treatment remains a controversial topic. We herein report a rare case of successful removal of giant mesothelial cyst that was incidentally detected during a medical checkup.
CASE PRESENTATION
A 53-year-old man with a feeling of mild chest tightness was referred to our hospital for the evaluation of an abnormal shadow of the mediastinum on chest X-ray. Computed tomography showed a multilocular, homogenous, large cyst in the superior mediastinum measuring 18 cm in size without contrast enhancement and with spotty calcification, and magnetic resonance imaging showed a low intensity on T1-weighted images and high intensity on T2-weighted images. Therefore, a cystic thymoma, thymic cyst, lymphangioma, cystic teratoma or pericardial cyst was suspected as the preoperative diagnosis. Despite mild symptoms, the patient underwent total thymectomy under median sternotomy for an appropriate diagnosis and treatment. The pathological diagnosis was giant multilocular mesothelial cyst.
CONCLUSIONS
Intrathoracic mesothelial cyst is a benign cyst and generally asymptomatic, but can sometimes induce critical chest clinical symptoms if untreated, depending on its size. In our case, complete surgical resection and a detailed pathological evaluation was effective for making the appropriate diagnosis and delivering treatment. In addition, an immunohistological evaluation is effective for diagnosing mesothelial cysts when it is difficult to distinguish the cyst from other cystic lesions.
PubMed: 33000344
DOI: 10.1186/s40792-020-01011-8 -
Indian Heart Journal 2017Pericardial cysts are rare with an incidence of about 1 in every 100,000 persons and one in 10 pericardial cysts may actually be a pericardial diverticulum. Pericardial... (Review)
Review
Pericardial cysts are rare with an incidence of about 1 in every 100,000 persons and one in 10 pericardial cysts may actually be a pericardial diverticulum. Pericardial cysts and diverticula share similar developmental origin and may appear as an incidental finding in chest roentgenogram in an asymptomatic patient. CT scan is considered as best modality for diagnosis and delineation of the surrounding anatomy. Cardiac MRI is recommended in the evaluation of the compressive effects caused by the pericardial cysts. The authors recommend echocardiography for serial follow up and image guided aspiration of the pericardial cyst in presence of compressive effects leading to cardiovascular and airway symptoms. A systematic approach is desirable for management of pericardial cysts depending on size, shape and compression effects, symptoms and easy access to serial Echocardiographic follow up. However, pericardial diverticulum may not be differentiated from cysts by the above testing, and only identified at surgery.
Topics: Algorithms; Diagnostic Imaging; Disease Management; Echocardiography; Humans; Mediastinal Cyst; Tomography, X-Ray Computed
PubMed: 28648435
DOI: 10.1016/j.ihj.2017.02.021 -
Surgery Journal (New York, N.Y.) Apr 2022Mediastinal cysts are benign lesions that may be seen in adulthood as well as in childhood. Mostly congenital lesions constitute 20 to 32% of lesions located in the...
Mediastinal cysts are benign lesions that may be seen in adulthood as well as in childhood. Mostly congenital lesions constitute 20 to 32% of lesions located in the mediastinum. The main cystic masses are congenital benign cysts (bronchogenic, esophageal replications, neuroenteric, pericardial and thymic cysts), meningocele, mature cystic teratoma, and lymphangioma. In this study, we aimed to analyze the mediastinal cysts operated in our clinic according to the histopathological type, surgical type, morbidity rates and to contribute to the literature on these rare lesions. The records of patients with mediastinal cysts who were operated in Gazi University Faculty of Medicine Department of Thoracic Surgery, between January 2013 and June 2021, were reviewed retrospectively. A total of 32 patients were included the study. Thirteen (40.6%) of the patients were male and 19 (59.4%) were female. The mean age was 45 (range: 12-71). The most common symptom in patients was chest pain with 12 patients. Histopathologically, the most common subtype was thymic cyst. Video-assisted thoracic surgery was applied in 19 patients (59.3%), thoracotomy in 8 patients (25%), and sternotomy in 5 patients (15.63%). There was no mortality. In patients with mediastinal cysts, the prognosis after complete excision is excellent and rates of morbidity and mortality associated with surgery are low.
PubMed: 35783027
DOI: 10.1055/s-0042-1749429 -
International Journal of Surgery Case... 2018A Müllerian cyst is a recently defined rare benign tumor of the posterior mediastinum. It is necessary to distinguish it from neurogenic tumor or bronchogenic cyst...
INTRODUCTION
A Müllerian cyst is a recently defined rare benign tumor of the posterior mediastinum. It is necessary to distinguish it from neurogenic tumor or bronchogenic cyst arising in the posterior mediastinum. Herein, we have reported and reviewed a case of Müllerian cyst in the light of the existing literature.
PRESENTATION OF A CASE
A 40-year-old woman was referred to our department for abnormal mediastinal tumor on computed tomography (CT). Chest CT revealed a 2-cm nodule in the left posterior mediastinum, while magnetic resonance imaging (MRI) T2-weighted scan revealed an elliptical, homogenous, and high-intensity neoplasm, and bronchogenic cyst or neurogenic tumor was suspected. She did not present with any symptoms. A thoracoscopic surgery was performed for the cyst removal. Histopathological examination revealed that the cyst wall was covered with a layer of columnar epithelium. Immunohistochemical staining revealed the presence of estrogen receptor (ER) and progesterone receptor (PgR). Therefore a diagnosis of mediastinal Müllerian cyst was made.
DISCUSSION AND CONCLUSION
It is important to differentiate Müllerian cyst in the posterior mediastinal from other mediastinal cystic tumor for optimal decision-making in treatment.
PubMed: 30015213
DOI: 10.1016/j.ijscr.2018.06.037