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Cureus Aug 2022The numerous causes underlying mediastinal lesions require different diagnostic and therapeutic approaches, including conservative, minimally invasive, and surgical... (Review)
Review
The numerous causes underlying mediastinal lesions require different diagnostic and therapeutic approaches, including conservative, minimally invasive, and surgical interventions. Solid lesions of a malignant nature, mostly located in the anterior mediastinum, are properly treated with surgical resection either with or without adjuvant schemes. In contrast, a surveillance program is usually recommended with solid benign tumors, depending on their size and related symptomatology. In the management of mediastinal collections, when a drainage intervention is required (suspicion of infection and symptomatology), a minimally invasive nonsurgical procedure or thoracic surgery is considered. The minimally invasive nonsurgical procedures that can be available are percutaneous radiology-guided imaging (abdominal ultrasound (US) or computed tomography (CT) scan), complete single-aspiration guided by endoscopic ultrasound (EUS) or endobronchial ultrasound (EBUS), and transmural drainage guided by EUS. Surgical debridement is feasible to treat collections, but as this entails considerable risk of postoperative complications, it is chosen only when other minimally invasive therapies are not possible. The published literature related to the interventional endoscopic approach to mediastinal lesions is scarce. Nevertheless, reports in this field reveal that interventional EUS may have a role in both the diagnosis of and therapeutic approach to mediastinal lesions, mainly in the management of mediastinal collections.
PubMed: 36106250
DOI: 10.7759/cureus.27803 -
Experimental and Therapeutic Medicine Nov 2022Mediastinal cysts are rare benign lesions and their diagnosis and treatment remain difficult and controversial. The development of endoscopic ultrasound (EUS) has...
Mediastinal cysts are rare benign lesions and their diagnosis and treatment remain difficult and controversial. The development of endoscopic ultrasound (EUS) has broadened the horizon for the precise treatment of diseases. The present study reports the case of a 53-year-old male hospitalized with chest pain. All imaging findings, including computed tomography, magnetic resonance imaging and EUS, indicated a benign cystic mass in the posterior mediastinum. The posterior mediastinal cyst was treated with EUS-guided fine-needle aspiration combined with an intracapsular injection of antibiotics and ethanol, and the results indicated no mediastinal infection after the puncture and no recurrence after 3 months of follow-up. The present study provides a new method for diagnosing and treating mediastinal cysts.
PubMed: 36277159
DOI: 10.3892/etm.2022.11628 -
Internal Medicine (Tokyo, Japan) 2010
Topics: Aged, 80 and over; Bronchitis; Bronchodilator Agents; Humans; Male; Mediastinal Cyst
PubMed: 20424379
DOI: 10.2169/internalmedicine.49.3318 -
Surgical Case Reports Dec 2017A mediastinal air cyst is a rare computed tomography (CT) finding. Once the lesion is identified, it is difficult to diagnose and treat. Meanwhile, bronchial diverticula...
BACKGROUND
A mediastinal air cyst is a rare computed tomography (CT) finding. Once the lesion is identified, it is difficult to diagnose and treat. Meanwhile, bronchial diverticula have been reported as a CT finding observed in certain pulmonary pathologic conditions. We encountered the case of an enlarged mediastinal air cyst accompanied with bronchial diverticula and upper lobe-dominant fibrous changes of the lung.
CASE PRESENTATION
A 69-year-old man with a chronic cough who had regularly visited a chest physician for upper lobe-dominant pulmonary fibrosis was referred to our hospital for the examination of an enlarged mediastinal air cyst. Chest CT exhibited an air cyst (size, 30 mm) connected to the lumen of the left main bronchus (LMB) and multiple tiny outpouches only on the LMB. Flexible bronchoscopy showed bubbling from slits or indentations of the bronchial mucosa only in the LMB but not in the right main bronchus or lobar bronchus. For therapeutic diagnosis, we removed the air cyst. Based on clinical, surgical, and pathological findings, we diagnosed the air cyst as an enlarged bronchial diverticulum.
CONCLUSIONS
This is the first case wherein bronchoscopic and surgical findings of bronchial diverticula and an enlarged bronchial diverticulum are reported. There are possible pathogenic mechanisms in cases of pulmonary disease that are attributable to enlargement of the bronchial diverticula.
PubMed: 28050776
DOI: 10.1186/s40792-016-0282-y -
International Journal of Surgery Case... Aug 2021Mediastinal cysts account for 20-32% of all mediastinal lesions. Complete surgical excision is the standard therapy for mediastinal cysts. Translucent cysts containing...
INTRODUCTION AND IMPORTANCE
Mediastinal cysts account for 20-32% of all mediastinal lesions. Complete surgical excision is the standard therapy for mediastinal cysts. Translucent cysts containing crystal-clear fluid are called "spring water cysts." We experienced a case of mediastinal spring water cyst fenestrated under video-assisted thoracoscopy with a miniaturized endoscope (mini-VATS) as an alternative to excisional resection.
CASE PRESENTATION
A 49-year-old woman presented with back pain. Chest CT revealed a posterior mediastinal mass measuring 4.2 × 1.8 × 3.2 cm closed to the tenth thoracic vertebra. Chest MRI demonstrated hypo-intensity on T1-weighted images and hyper-intensity on T2-weighted images. It was estimated that the posterior mediastinal mass did not contain a tumor component. The tumor was growing and symptomatic; therefore, we performed surgical cyst fenestration without excision of the cyst under mini-VATS. The patient experienced complete relief of symptoms. Fluid accumulation in the cyst was not observed on CT images 12 months postoperatively.
CLINICAL DISCUSSION
Kozu et al. reported that all 108 primary mediastinal cysts were resected completely and were recurrence-free after a mean follow-up of 41 ± 26 months. In the case of a functional hydrocele such as spring water cyst, we believe that even if fluid is produced, the thoracic pleura is capable of absorbing the fluid, and the cyst wall might not recur even if the wall is left in place. Fluid drainage through fenestration may prevent recurrent fluid collection.
CONCLUSION
Fenestration of non-neoplastic mediastinal cysts under mini-VATS might be a less invasive radical procedure compared to complete resection.
PubMed: 34393096
DOI: 10.1016/j.ijscr.2021.106293 -
Annals of Thoracic and Cardiovascular... 2014Hydatid disease is endemic in many parts of the world. Mediastinal hydatidosis is seen less than 0.1% of all hydatid diseases. We want to report our primary mediastinal...
PURPOSE
Hydatid disease is endemic in many parts of the world. Mediastinal hydatidosis is seen less than 0.1% of all hydatid diseases. We want to report our primary mediastinal hydatid cysts.
MATERIALS AND METHODS
In this retrospective study, from January 2010 to December 2012, 158 patients with intrathoracic hydatid cysts were operated in our thoracic surgery clinic. Nine of 158 (5.69%) patients had mediastinal hydatid cyst. Chest X-ray and computed tomography (CT) were used as diagnostic tools.
RESULTS
Hydatid cyst was confirmed surgically and pathologically in all the patients. Anterior mediastinal hydatid cysts and one cardiac involvement were determined in our study. While total cyst excision was performed in seven patients, partial pericystectomy could be done in two patients. In one patient, left ventricle invasion was seen and it was totally excised. Postoperative albendazole was applied to patients and there was no recurrence of disease till now.
CONCLUSIONS
Mediastinal hydatid cysts are uncommon and should be kept in mind in differential diagnosis of mediastinal cystic lesions especially in endemic regions. Surgical resection must be done and then medical therapy is needed to prevent recurrence.
Topics: Adolescent; Adult; Albendazole; Anthelmintics; Echinococcosis; Female; Humans; Male; Mediastinal Cyst; Middle Aged; Retrospective Studies; Thoracic Surgical Procedures; Tomography, X-Ray Computed; Treatment Outcome; Young Adult
PubMed: 23801183
DOI: 10.5761/atcs.oa.13.02273 -
Thorax Jul 1974, 475-481. A review of 28 patients with primary mediastinal tumours seen over a five-year period is presented. Clinical and pathological features of a heterogeneous...
, 475-481. A review of 28 patients with primary mediastinal tumours seen over a five-year period is presented. Clinical and pathological features of a heterogeneous group of tumours are emphasized. Since a number of patients presented with mild symptoms or were asymptomatic (especially adults), the importance of routine chest radiographs is stressed. Complete excision was accomplished in all patients with benign lesions. Malignant lesions were usually partially resectable and carried a poor prognosis.
Topics: Adenocarcinoma, Papillary; Adolescent; Adult; Aged; Child; Child, Preschool; Chondrosarcoma; Dermoid Cyst; Female; Fibrosarcoma; Hodgkin Disease; Humans; Lipoma; Lymphoma; Lymphoma, Large B-Cell, Diffuse; Lymphoma, Non-Hodgkin; Male; Mediastinal Neoplasms; Mediastinum; Middle Aged; Neurofibroma; Osteoma; Radiography; Respiration; Teratoma; Thymoma
PubMed: 4604946
DOI: 10.1136/thx.29.4.475 -
Insights Into Imaging Aug 2022Chest MRI is a useful diagnostic modality for the evaluation of anterior mediastinal lesions but the outcomes of anterior mediastinal cystic lesions diagnosed on chest...
BACKGROUND
Chest MRI is a useful diagnostic modality for the evaluation of anterior mediastinal lesions but the outcomes of anterior mediastinal cystic lesions diagnosed on chest MRI are unclear.
METHODS
In this multicenter retrospective study, patients who underwent contrast-enhanced chest MRI in two tertiary centers to assess anterior mediastinal cystic lesions were included after excluding overt solid tumors and thymic hyperplasia. Anterior mediastinal cystic lesions were classified into two categories: probable (simple) cyst or indeterminate lesion (complex cyst). Size and imaging features of lesions during follow-up were evaluated and clinical outcomes were assessed.
RESULTS
A total of 204 patients (mean age, 59 ± 11 years; M:F = 111:93) were studied; 186 (91.2%) were classified as probable cysts and 18 (8.8%) as indeterminate lesions on MRI. Among patients with probable cysts and more than 2 years of follow-up, lesion size was unchanged in 39.6% (36/91), decreased in 16.5% (15/91), and fluctuated in 8.8% (8/91). All patients who underwent surgery were confirmed cysts. None developed mural nodules or irregular wall thickening, suspicious for malignancy during follow-up. In patients with indeterminate lesions, 16.7% (3/18) had pathologically confirmed thymoma and 44.4% (8/18) had proven cysts. Follow-up numbers and intervals after MRI in patients with probable cysts were variable among physicians and institutions in clinical practice (p < 0.05) but more than half were followed for up to 2 years in two centers.
CONCLUSION
Diagnosing anterior mediastinal cysts using MRI is reliable. MRI-based management of anterior mediastinal lesions may reduce the number of unnecessary follow-ups and surgeries.
PubMed: 35976511
DOI: 10.1186/s13244-022-01275-8 -
Journal of Thoracic Disease Sep 2022Mediastinal cysts are uncommon, and their diagnosis remains a clinical challenge, especially for patients with a solid mass on computed tomography (CT). Endoscopic...
BACKGROUND
Mediastinal cysts are uncommon, and their diagnosis remains a clinical challenge, especially for patients with a solid mass on computed tomography (CT). Endoscopic ultrasound (EUS) is considered a valuable method to differentiate mediastinal cysts and EUS-fine needle aspiration (FNA) is a strategy for obtaining specimens from the cysts for cytological diagnosis. This study aims to evaluate the safety and utility of EUS-FNA for diagnosis of mediastinal cysts.
METHODS
This was a retrospective analysis of patients who underwent EUS-FNA with 19-gauge needle at Tianjin Medical University Cancer Institute and Hospital and were further diagnosed with mediastinal cysts confirmed by cytological and surgical pathological results between January 2016 and December 2020. Safety was estimated by the incidence of reported adverse events (AEs). Patients were followed for 48 hours and 1 week after the EUS-FNA procedure to evaluate AEs.
RESULTS
A total of 20 patients were diagnosed with mediastinal cysts using EUS-FNA, yet only 5 were diagnosed by CT. There were 15 patients diagnosed with bronchogenic cyst, 4 with enteric cyst, and 1 with pericardial cyst. The EUS appearance of cyst content varied, ranging from anechoic (4 cases) to hypoechoic (16 cases). AEs occurred in 2/20 (10%) patients after the EUS-FNA indicating an acceptable low rate of AEs. For all anechoic cysts that underwent complete FNA drainage, 3 patients had good prognosis, whereas 1 experienced recurrence. For 16 patients with hypoechoic cysts, adequate tissue was obtained for cytological examination. No patient developed an infection-related complication.
CONCLUSIONS
For the diagnosis of mediastinal cysts, EUS-FNA was more accurate than CT. The EUS-FNA of mediastinal cysts is safe with an acceptable low rate of AEs when antibiotic prophylaxis is used postoperatively. Cysts containing free-flowing fluid can be achieved with complete needle drainage by a single pass with a 19-gauge needle.
PubMed: 36245595
DOI: 10.21037/jtd-22-1105 -
La Tunisie Medicalemediastinal cysts are rare lesions developed from mediastinal structures. They may be acquired like thoracic duct cysts or lymphangiomas or congenital like the...
INTRODUCTION
mediastinal cysts are rare lesions developed from mediastinal structures. They may be acquired like thoracic duct cysts or lymphangiomas or congenital like the bronchogenic cysts, enteric cysts or celomic cysts. These cysts are rare and may cause diagnostic challenges.
AIM
To assess the major characteristics of these cysts based on a single institution experience.
METHODS
the authors performed a descriptive, retrospective study from January 2009 to March 2020 in a single institution. Cystic lesions taking birth from the mediastinum for which gross features, microscopic features were available were included.
RESULTS
this study contained 52 mediastinal cysts that were completely resected and no patient presented complications after the surgical resection. The bronchogenic cysts were the most frequent and represented 57.69% of all lesions. Thymic cysts and pericardial cysts represented respectively 40.38% and 1.92% of the cases. The positive diagnosis was based on the microscopic exam. The final diagnosis was concordant with the radiologic findings in 15 cases reaching a rate of 28%.
CONCLUSION
the diagnosis of mediastinal cysts is based on the microscopic analysis of the cystic wall. Pericardial cysts may be suspected based on their characteristic location in the cardiophrenic angle, thymic cyst may be evoked based on their location in the thymic region and bronchogenic cysts are mainly located in the middle mediastinum. Inspite of these most frequent locations, the cysts may be located in any part of the mediastinum and may be difficult to diagnose when the key diagnostic features are absent.
Topics: Bronchogenic Cyst; Humans; Mediastinal Cyst; Retrospective Studies
PubMed: 35822331
DOI: No ID Found