Nonparasitic Splenic Cysts in Children: Outcomes after Sclerotherapy or Surgical Resection as Initial Management.

Management of splenic cysts in children remains undefined. Sclerotherapy is an innovative, less invasive treatment. This study examined the safety and preliminary effectiveness of sclerotherapy for splenic cysts in children compared with those of surgical treatment. A retrospective review of pediatric patients treated for nonparasitic splenic cysts from 2007 to 2021 was performed at a single institution. Posttreatment outcomes for patients who underwent either expectant management, sclerotherapy, or surgery were reviewed. Thirty patients aged between 0 and 18 years met the inclusion criteria. Cysts in 3 of 8 patients who underwent sclerotherapy were either unresolved or recurred. Patients who underwent sclerotherapy and required surgery for residual symptomatic cyst had an initial cyst diameter of >8 cm. Symptoms resolved in 5 of 8 patients who underwent sclerotherapy, with a significantly reduced cyst size compared with that in patients with continued symptoms who underwent sclerotherapy (61.4% vs 7.0%, P = .01). Sclerotherapy is an effective treatment for splenic cysts, particularly those measuring <8 cm. However, surgical excision may be preferable for large cysts.

Retrospective analysis of ultrasound-guided minimally invasive treatment of various thyroid cysts.

PURPOSE: The aim of this article was to determine the efficacy and safety of the combined use of ethanol and microwave (MWA) to thyroid cysts and explore the differences of various cysts. MATERIALS AND METHODS: A total of 136 patients and 142 thyroid cystic nodules and predominantly cystic nodules received combination therapy of ethanol and MWA between January 2016 and December 2019 in BeiJing Friendship Hospital. They were divided into different groups according to the size, and the characteristics of fluid aspirated. We compared the Initial size, treatment procedure, postoperative complications, and follow-up results to analyze the characteristics of different groups. RESULTS: The combination treatments reduced the size of cysts by more than 93% with less complications at the end of follow-up. The treatment duration was longest in the colloid cysts (difference from the clear-fluid group, p < 0.01), the absolute volume of the clear-fluid group at the end of follow-up was the smallest (difference from the other two groups: P < 0.01).There were the similar mean volume reduction rate (VRR) between the large cysts and the small cysts (p > 0.05). CONCLUSION: The combination treatments were applicable to all types of cysts. Understanding the characteristics of different cystic nodules and adopting different methods are helpful for us to carry out the minimally invasive treatment of cysts better.

Systematic review on percutaneous aspiration and sclerotherapy versus surgery in symptomatic simple hepatic cysts.

BACKGROUND: Simple hepatic cysts (SHC) may cause pain and bloating and thus impair quality of life. Whereas current guidelines recommend laparoscopic cyst deroofing, percutaneous aspiration and sclerotherapy (PAS) may be used as a less invasive alternative. This review aimed to assess the efficacy of PAS and surgical management in patients with symptomatic SHC. METHODS: A systematic search in PubMed and Embase was performed according to PRISMA-guidelines. Studies reporting symptoms were included. Methodological quality was assessed by the MINORS-tool. Primary outcomes were symptom relief, symptomatic recurrence and quality of life, for which a meta-analysis of proportions was performed. RESULTS: In total, 736 patients from 34 studies were included of whom 265 (36%) underwent PAS, 348 (47%) laparoscopic cyst deroofing, and 123 (17%) open surgical management. During weighted mean follow-up of 26.1, 38.2 and 21.3 months, symptoms persisted in 3.5%, 2.1%, 4.2%, for PAS, laparoscopic and open surgical management, respectively. Major complication rates were 0.8%, 1.7%, and 2.4% and cyst recurrence rates were 0.0%, 5.6%, and 7.7%, respectively. CONCLUSION: Outcomes of PAS for symptomatic SHC appear to be excellent. Studies including a step-up approach which reserves laparoscopic cyst deroofing for symptomatic recurrence after one or two PAS procedures are needed.

Intralesional sclerotherapy for the treatment of acne cysts: A case series.

Acne cysts are a common dermatological problem that often leads to scarring and a significant negative impact on patients' psyche. The aim of the study was to evaluate the usefulness of intralesional foam sclerotherapy for the treatment of cystic acne. Patients with cystic acne treated with intralesional foam sclerotherapy between June 2018 and May 2019 were identified. Treatment response and adverse effects were assessed during follow-up. Twelve patients (10 men and 2 women) with cystic acne with a median age of 21 years were treated during the study period. Of these 12 patients, eight (66.7%) showed complete resolution within 48 hours and two (16.7%) experienced complete resolution within 1 week. Two patients failed treatment at the end of the 4-week follow-up. Of the two patients with more than one acne cyst, response was noted only at the treated site. All patients who showed improvement sustained the effects at the 12-week follow-up. No adverse effects were observed and the treated sites healed with good cosmesis and minimal scarring. To conclude, single-session percutaneous polidocanol sclerotherapy is useful for the treatment of acne cysts. Future controlled studies are required to compare the efficacy of intralesional sclerotherapy with intralesional corticosteroids.

Aspiration-sclerotherapy versus laparoscopic de-roofing in the treatment of renal cysts: which is better?

BACKGROUND: To compare the clinical efficiency between aspiration-sclerotherapy (AS) and laparoscopic de-roofing (LD) in the management of renal cysts through meta-analysis of comparative studies. METHOD: A comprehensive literature search was performed by PubMed, MEDLINE, Ovid and Web of Science for relevant studies published up to January 2020. The statistical analyses were conducted with Review Manager 5.3.0 and Stata 15.1. The sensitivity analysis was also carried out to confirm the reliability of this Meta-analysis. RESULTS: Our searches of literature generated 6 studies (1547 patients incorporated) comparing AS with LD in the impacts of renal cyst therapy. Of these, 6 studies contained 1106 and 441 patients who were treated with AS and LD, respectively. The outcome of this meta-analysis indicated that LD group was superior in symptomatic successful rate [Odds Ratio (OR): 0.28; 95%Confidence Interval (CI): 0.09 to 0.86; P = 0.03), radiological successful rate (OR: 0.06; 95%CI: 0.02 to 0.15; P < 0.01) and recurrence rate (OR: 6.08; 95%CI: 2.81 to 13.15; p < 0.01). Nevertheless, AS group had shorter treatment time [Mean Difference (MD):-51.10; 95% CI:-73.01 to - 29.20; p < 0.01]. No statistically significant difference was showed in the rate of complications (OR: 3.19; 95% CI: 0.39 to 25.88; P = 0.28). CONCLUSIONS: In our meta-analysis, LD had higher symptomatic successful rate, radiological successful rate as well as lower recurrence rate than AS, while the treatment time was longer.

Transarterial embolisation with bleomycin and N-butyl-2-cyanoacrylate -Lipiodol mixture for symptomatic polycystic liver disease: preliminary experience.

AIMS: To evaluate the therapeutic effect and safety of transarterial embolisation using a bleomycin-Lipiodol mixture and N-butyl-2-cyanoacrylate (NBCA)-Lipiodol mixture (BNL) for the treatment of polycystic liver disease (PLD). MATERIALS AND METHODS: From June 2012 to July 2018, a total of consecutive 14 symptomatic patients (13 women and 1 man; mean age, 49.3±9.9 years) with PLD were referred and underwent transcatheter arterial embolisation (TAE) with BNL. RESULTS: Technical success was achieved in all cases. PLD-related severe symptoms were improved remarkably in 13 of the treated patients. The mean maximum abdominal circumference decreased significantly from 100.6±9.4 to 94.9±9.1 cm (p<0.01). The total liver volume decreased significantly compared with pre-TAE in 13 patients at 6-12 months after TAE. It decreased from 9,776±2,219 to 8,303±2,009 cm3 (p<0.01). There were no major complications associated with the procedure. CONCLUSION: TAE with the bleomycin-Lipiodol mixture and NBCA-Lipiodol mixture may be an effective method for treating symptomatic PLD patients, with improvement of symptoms and shrinkage of cyst volume.

Different Successful Management Strategies for Obstructing Renal Parapelvic Cysts.

Parapelvic cysts originate in the renal parenchyma and extend into the renal sinus. A series of 3 patients with symptomatic obstructing parapelvic cysts is described, 2 with acute presentations, and 1 with chronic symptoms. In 2 of the 3 cases, there was a significant delay in establishing a diagnosis. Although one individual was successfully managed by image-guided cyst aspiration, the second patient required repeated aspiration due to cyst re-accumulation. A high index of clinical suspicion and a combination of imaging modalities, including serial ultrasound, excretory-phase CT, and MAG3 renogram, are necessary to establish the diagnosis and monitor response to treatment.

[LASER-INDUCED SCLEROTHERAPY OF MAMMARY GLAND CYSTS].

Own experience of the patients treatment for the mammary gland cysts (MGC) in its benign dysplasia was analyzed. Comparative analysis of efficacy of a laser-induced sclerotherapy for the MGC and chemical sclerosing (96% еthanol) was conducted. There was established, that the cyst recurrency rate depends upon volume of the cavity and it is reducing while application of a laser-induced sclerotherapy.

Process of Care for Patients With Benign Cysts and Tumors: Consensus Document of the Andalusian Regional Section of the Spanish Academy of Dermatology and Venereology (AEDV). / Proceso de atención a las personas con lesiones quísticas y tumorales benignas. Documento de consenso de la sección territorial andaluza de la Academia Española de Dermatología Médico-Quirúrgica y Venereología.

Benign skin lesions are a common reason for visits to primary care physicians and dermatologists. However, access to diagnosis and treatment for these lesions varies considerably between users, primarily because no explicit or standardized criteria for dealing with these patients have been defined. Principally with a view to reducing this variability in the care of patients with benign cysts or tumors, the Andalusian Regional Section of the Spanish Academy of Dermatology and Venereology (AEDV) has created a Process of Care document that describes a clinical pathway and quality-of-care characteristics for each action. This report also makes recommendations for decision-making with respect to lesions of this type.

Evaluation of efficacy, safety, pain perception and health-related quality of life of percutaneous ethanol injection as first-line treatment in symptomatic thyroid cysts.

BACKGROUND: To evaluate the efficacy, safety, pain perception and health-related quality of life (QoL) of percutaneous ethanol injection treatment (PEIT) as an alternative to thyroid surgery in symptomatic thyroid cysts. METHODS: Thirty consecutive patients (46 ± 10 years; 82% women) with symptomatic benign thyroid cysts relapsed after drainage were included. In all cases, cytology prior to treatment, maximum cyst diameter and volume were determined. PEIT was conducted using the established procedure, and the volume of fluid removed and pain perceived by the patient were assessed. In each procedure, the volume of alcohol instilled was <2 ml. After follow-up, final cyst diameter and volume were determined and the persistence of symptoms and QoL were assessed by a questionnaire (SF-36). RESULTS: Mean symptom duration was 10 ± 20 months. A single session of PEIT was required to complete the procedure in 45% of patients, two in 31% and three in 13%. Mean initial maximum cyst diameter was 3.5 ± 1.0 cm and mean extracted liquid volume 61 ± 36 ml. During PEIT, 39% of patients experienced virtually no pain, 43% mild pain and 17% moderate pain. No complications of PEIT were observed. After 12.1 ± 1.4 months of follow-up, cysts were reduced more than 70% in volume in 86.3% of patients, more than 80% in 61.9% and more than 90% in 42%. On the health-related QoL SF-36 questionnaire, patient scores 6 months post-PEIT did not differ significantly from those of the healthy Spanish population. With respect to cosmetic complaints or local symptoms of compression, PEIT-treated patients presented an initial score of 22 ± 8 and 13 ± 5 after treatment (p < 0.05). CONCLUSIONS: In our experience, percutaneous ethanol injection has prove to be an effective, safe and well-tolerated first-line treatment of symptomatic thyroid cysts.

Curative effect of lauromacrogol and absolute ethyl alcohol injection guided by ultrasound on simplex hepatic cyst.

This research aims to analyze the curative effect and security of lauromacrogol injection and absolute ethyl alcohol treating simplex hepatic cyst respectively. The simplex hepatic cyst patients were divided into lauromacrogol group (86 cases, research group) and absolute ethyl alcohol group (80 cases, control group). Both two groups received sclerotherapy of thoracic drainage under ultrasonic guidance and the curative effect and untoward effect were observed. The result showed there was no hemorrhage or infection within two groups. During the therapeutic process, 45 patients (56.3%) suffered from pain at different degrees and 23 cases were found with symptom of drunkenness in control group, while the patients in the research group were found with no obvious discomfort. A week after treatment, 23 patients (25.0%) in control group still remained to have swelling pain at upper right stomach, while there were only 9 in treatment group (10.5%), and the difference was of statistical significance (X(2)=6.037, P<0.05). through 6 months of follow-up visit after the operation, we found the cure rate of lauromacrogol group was 94.6% and absolute ethyl alcohol was 92.6%, and the difference between these two groups was of no statistical significance (P>0.05). The results showed that, in the treatment of cystosclerosis with absolute ethyl alcohol injection under ultrasonic guidance, some patients suffered pain and the symptom of drunkenness at different degrees, whereas, lauromacrogol was effective with no untoward effects, therefore it is worthy of clinical popularization and application.

[Ultrasound-guided aspiration for treatment of symptomatic cystic adventitial disease of the popliteal artery]. / Opis przypadku przezskórnej aspiracji torbieli podprzydankowej tetnicy podkolanowej wykonanej pod kontrola USG.

Cystic adventital disease is a very rare lesion of peripheral arteries. The cysts usually occur in the popliteal arteries, they contain gelatinous substance and by eccentric compression of the lumen of the artery may cause calf claudication. We report a case of decompression of the popliteal artery by percutaneous ultrasound guided adventitial cyst aspiration in an 80-year-old patient complaining of intermittent claudication. The procedure resulted in normal flow in the popliteal artery and resolution of symptoms. Such procedure is efficacious, safe and can be performed on an outpatient basis.

Percutaneous Internal Drainage in Symptomatic Renal Parapelvic Cyst Refractory to Sclerotherapy: A Case Report.

Percutaneous sclerotherapy is a safe and effective treatment for renal parapelvic cysts. However, if the cyst is in communication with the adjacent renal pelvocalyceal system, sclerotherapy is contraindicated and alternative treatment should be considered. Here, we report a case of a patient with a symptomatic renal parapelvic cyst that was treated using a novel technique involving percutaneous new tract formation between the cyst and renal pelvis.

Recurrent pulmonary arteriovenous malformation in a patient with Sjögren syndrome: A case report.

RATIONALE: Pulmonary manifestations of Sjögren syndrome (SS) are variable and may involve the airway or lung parenchyma and increase the risk of vascular and malignant disease. However, to date, only one case of pulmonary arteriovenous malformation (AVM) has been reported in a patient with SS. Here, we report a rare case of recurrent pulmonary AVMs with aggravating multiple cysts in a patient with SS during a period of 14 years. PATIENT CONCERNS: A 45-year-old woman was diagnosed with SS and pulmonary AVM in the right lung. Her AVMs were embolized successfully and she was followed up annually for 14 years. Eleven years after the initial treatment, her chest computed tomography showed new pulmonary AVMs in the left lung with aggravating multiple cysts. DIAGNOSIS: We diagnosed her with SS according to the American-European consensus group criteria of 2010. Chest computed tomography and angiographic findings confirmed the recurrence of pulmonary AVMs. INTERVENTIONS: The patient's recurrent pulmonary AVMs were successfully treated by embolization. OUTCOMES: Although her multiple cystic lung lesions had been aggravating during 14 years, she received embolization for the pulmonary AVMs twice and developed no complication related to these procedures. Currently, the patient is 56 years old and still alive with good performance state. LESSONS: To date, only one case of pulmonary AVM has been reported in a patient with SS. The patient died 2.5 years after the diagnosis without recurrence of AVM. Here, we present a rare case of recurrent pulmonary AVMs associated with aggravating multiple cysts in both lungs, which were observed during long-term follow-up, in a patient with SS.

Mesencephalic enlarged Virchow-Robin spaces in a 6-year-old boy: a case-based update.

BACKGROUND: Perivascular spaces or Virchow-Robin spaces are normal anatomical structures within the brain, typically less than 5 mm in diameter. Rarely, they can reach much larger sizes and adopt bizarre single or multi-cystic configurations, as was the case in the patient that we report on. When there is such markedly gross dilatation, the phenomenon is known as Giant or tumefactive perivascular space enlargement. CASE REPORT: We report a 6-year-old boy with a multi-cystic mesencephalic lesions presenting with obstructive hydrocephalus secondary to obstruction of the aqueduct of Sylvius due to tumefactive dilatation of Virchow-Robin spaces. The patient underwent an endoscopic fenestration and biopsy of the cystic portion abutting into the ventricular system. CONCLUSION: In this paper, we discuss the phenomenon of perivascular (Virchow-Robin) spaces and their treatment options and review the relevant literature. To our knowledge, this is the first pediatric case of tumefactive dilatation of the Virchow-Robin spaces causing obstructive hydrocephalus that were directly fenestrated using neuroendoscopy.

Ultrasound-guided aspiration and ethanol sclerotherapy for treating endometrial cysts.

PURPOSE: The authors sought to evaluate the effectiveness of ultrasound (US)-guided aspiration and ethanol sclerotherapy in treating endometrial cysts and adopt this procedure as an alternative to surgery. MATERIALS AND METHODS: Fifty consecutive patients with an average age of 25.2 years [standard deviation (SD) 6.5; range 16-40 years) and US diagnosis of endometrial cyst who were pregnant or presenting with high anaesthesia risk, adhesions or who refused surgery underwent US-guided aspiration of a total of 54 endometrial cysts (40 with transabdominal approach and the remaining 14 with transvaginal approach) and ethanol sclerotherapy. RESULTS: The procedure was successful in all patients. Follow-up imaging was carried out at 12 h, 24 h, 15 days, 3 months, 6 months and 12 months. After 12 months, four patients (8%) showed recurrence, three of whom opted for a second session of US-guided aspiration and ethanol sclerotherapy. CONCLUSIONS: US-guided aspiration and sclerotherapy with 95% ethanol provides a valid alternative to surgery in treating endometrial cysts.

A Comparative Study of Percutaneous Aspiration with Sclerotherapy and Laparoscopic Marsupialization for Symptomatic Simple Renal Cysts.

Background: Percutaneous aspiration with sclerotherapy (PAS) and laparoscopic marsupialization (LM) are minimally invasive treatment modalities for renal cysts. We aimed to compare the efficacy and cost/effectiveness of LM and PAS for the treatment of simple symptomatic renal cysts. Methods: Data were prospectively collected from three health care institutions in which 80 patients with symptomatic simple renal cysts underwent a single session of PAS with 95% ethanol (PAS group, n = 40) or underwent LM under general anesthesia (LM group, n = 40) between March 2012 and May 2016. We compared the patient profile, duration of procedure, duration of hospital stay, radiological and symptomatic success rates, treatment costs, and incidence of complications between the two groups. Results: At the 6-month follow-up, the radiological success rate in the LM group was significantly greater than that in the PAS group (97.5% versus 60%; P < .001). The symptomatic success rate was comparable in the two groups (95% versus 90%; P = .675). The treatment failure rate did not significantly differ between the two groups (5.0% versus 17.5%, P = .154). The mean total cost in the PAS and LM groups was 1256 USD and 2343 USD, respectively (P = .001). No significant between-group difference was noted regarding the overall complication rate (P = .615). Conclusions: Both LM and PAS are effective and safe procedures for the treatment of symptomatic simple renal cysts. A single session of PAS seems to be a cost-effective method for the management of symptomatic simple renal cysts.

Differential diagnosis and management of a recurrent hepatic cyst: a case report and review of literature.

Echinococcus granulosus, which causes cystic echinococcosis, is an uncommon condition in the United States. We report a case of a 78-year-old Caucasian female who presented to her primary care physician in 1999 with right upper quadrant pain. She had a history of frequent foreign travel. Abdominal imaging demonstrated a 12.5-cm hepatic cyst. The cyst was drained and the pathology report on the fluid indicated no bacterial, parasitic, or malignant etiology. Serology tests for Entamoeba and Echinococcus antibodies were negative. The patient underwent multiple hepatic cyst aspirations until 2008 for recurring symptoms. In 2008, abdominal imaging demonstrated solid internal components within the cyst. Repeat Echinococcus antibodies ordered were abnormally elevated. Cyst aspiration demonstrated Echinococcus protoscolex. We report this case to discuss the diagnosis and management of hydatid cyst and to emphasize that with increasing globalization, physicians must maintain a high index of clinical suspicion for parasitic etiologies in patients with hepatic cysts.