Surgical Dilemma: Exomphalos Major with Accessory Liver Lobe and Congenital Liver Cysts.

The association of exomphalos major, congenital liver cysts, and an accessory lobe of the liver is very rare. There are only two previously reported cases in the literature, both describing surgical excision of the accessory lobe with liver cysts during primary closure of the exomphalos defect. We report a case of this rare association, managed by delayed primary closure, where the cysts underwent spontaneous regression. This case, along with those previously reported, supports the etiopathogenesis theory of a malformative sequence of exomphalos and hepatic trauma within the sac of this rare association. Spontaneous regression of these cysts would favor a delayed primary closure in such cases.

Airway compromise and thyroglossal duct cysts in adulthood.

A 61-year-old man died suddenly after a brief history of shortness of breath and hemoptysis. At autopsy he had lobar pneumonia involving the right upper and left lower lobes of the lung. Significantly there was also a 30 × 20 mm (in cross-section) thyroglossal duct cyst compressing the upper airway. Death was attributed to respiratory failure due to the combined effects of lobar pneumonia (cultures positive for Streptococcus pneumoniae) and airway narrowing from a thyroglossal duct cyst. Although such cysts are usually found in childhood they may on occasion be diagnosed in adults. Despite being the most common congenital cyst in the neck cases associated with a lethal outcome are extremely rare.

Subcutaneous dermoid cysts on the eyebrow and neck.

We report a case of dermoid cysts on the right lateral eyebrow and anterior neck. Multiple concurrent dermoid cysts, as in the present case, are very rare. The differential diagnosis of dermoid cyst includes epidermoid (epidermal inclusion) cyst, trichilemmal cyst, pilomatrixoma, lymphatic malformation, and lipoma. In particular, thyroglossal duct cyst and midline anterior neck inclusion cyst are part of the differential diagnosis when the lesion is in the anterior neck.

Case report of parapneumonic effusion and mesothelial subdiaphragmatic cyst: relationship or coincidence?

Parapneumonic pleural effusions are common in patients with pneumonia. When colonized by pathogenic bacteria or other microorganisms, these effusions can progress to empyema. Additionally, empyema formation may result in extension of the infection into the infradiaphragmatic region, further complicating the clinical scenario. Many subphrenic collections are found to be mesothelial cysts, which are congenital in origin. However, data regarding the potential association between mesothelial diaphragmatic cysts and parapneumonic effusions are limited. We herein describe a toddler with pneumonia complicated by parapneumonic effusion and a lung abscess with a subphrenic collection. After abscess drainage and a full course of antibiotics, imaging revealed clear lung parenchyma with an interval resolution of the effusion and a persistent unchanged subphrenic collection that was confirmed to be mesothelial diaphragmatic cyst. This case highlights the fact that not every subphrenic collection associated with parapneumonic effusion is a communicated collection formed by seeding. Such a collection can instead be an incidental cyst, which is congenital in origin and known as a mesothelial diaphragmatic cyst. A diaphragmatic mesothelial cyst is an uncommon benign congenital cyst that is unrelated to an adjacent parapneumonic effusion. It is usually incidental and can be monitored without invasive intervention.

Spontaneous self-expulsion of an oesophageal duplication cyst.

A case report of an oesophageal duplication cyst in an adult patient with chronic cough and presenting with a "coughed out lump". This is an unusual presentation highlighting the importance of considering congenital duplication cysts in patients with chronic cough and no obvious respiratory cause.

Surgical Experiences of Pediatric Cervical Bronchogenic Cysts: A Case Series of 6 Patients.

OBJECTIVES: Bronchogenic cyst is a rare congenital disease which occurs especially in the neck region. This report presents 6 cases of bronchogenic cysts and discusses the diagnosis and surgical experience of this anomaly. METHODS: A retrospective study of 6 pediatric patients with cervical bronchogenic cysts treated in our hospital during 2016 to 2019 was performed. We recorded and analyzed the clinical data of the patients, including age, symptoms, imaging findings, surgical procedure, and complications. RESULTS: All patients underwent surgical excision. The chondroid tissues were found at the base of cysts which clung to the trachea in 5 patients and completely removed by surgery without recurrence. One patient showed recurrence due to residual cartilage after the first surgery, and the second surgery was required to resect the remaining cartilage. During the surgery, the recurrent laryngeal nerve (RLN) detector was used, which confirmed that all the RLNs clung to the side wall of cysts. All cases were cured without complications. CONCLUSIONS: Although rare, bronchogenic cysts should be considered in the differential diagnosis of peritracheal masses in children. Complete resection of the bronchogenic cysts, including the cartilages at the base, is vital in preventing recurrence. The RLN must be protected during the surgery.

Common Neck and Otomastoid Infections in Children.

Neck infections are common in children, though the clinical presentation is often vague and nonspecific. Therefore, imaging plays a key role in identifying the site and extent of infections, evaluating for potentially drainable collections, and assessing for airway and vascular complications. This review focuses on imaging features associated with common and characteristic neck infections in children to include tonsillar, retropharyngeal, and otomastoid infections; suppurative adenopathy; superimposed inflammation or infection of congenital cystic lesions; and Lemierre syndrome.

Giant cholesterol granuloma of petrous apex.

Cholesterol granulomas are chronic inflammatory lesions located primarily in the apex of the petrous part of the temporal bone. They are benign, tumor-like lesions, consisting of a cystic cavity filled with a chocolate-brown fluid and present as hyperintense masses on T1 and T2 sequences on MRI. The most common causes of cholesterol granulomas are chronic middle ear infections and traumas, explaining their prevalence in young to middle aged patients. Due to their progressively expanding nature, clinical presentation include vertigo, diplopia, tinnitus, hearing loss and seizures. Treatment of cholesterol granulomas consists of two different approaches: watch and wait or radical surgery to remove the granulomatous tissue. We present the case of a 38-year-old male patient who was admitted to the Neurology Clinic with complaints of loss of consciousness, headache, pain on the left side of the face and tinnitus in the left ear. These symptoms had been present for some time and gradually worsened in intensity and frequency. Initially after an EEG was performed, the patient showed signs of focal epilepsy and began treatment accordingly. Subsequently, a CT and an MRI of the head and neck were performed, which showed a large, well demarcated expansile mass within the left petrous apex, which was hyperintense on T1 and T2. Based on his clinical presentation and radiologic findings, a diagnosis of cholesterol granuloma was established. Through this case report we hope to emphasize the role imaging modalities play in the diagnosis and appropriate management of cholesterol granulomas.

Antenatally diagnosed intraspinal-posterior mediastinal neurenteric cyst - what is the optimal management?

Neurenteric cyst is a rare congenital anomaly that belongs to the spinal dysraphism spectrum. It is classically a disease of late childhood, with some rare reports of intrauterine and adult presentation. The increase in incidental antenatal diagnosis raises new management questions. We present a case of an asymptomatic combined intraspinal-posterior mediastinal neurenteric cyst. The cyst was diagnosed on antenatal ultrasound and was initially treated with image-guided aspiration in early infancy. However, the cyst recurred and the patient developed recurrent episodes of bacterial meningitis. Two-stage surgical resection was performed, although the infection prohibited complete excision. We caution against image guided aspiration of neurenteric cysts, and suggest a management algorithm based on the available literature.

Diagnostic and Operative Challenges in a Type I First Branchial Cleft Cyst: A Case Report.

First branchial cleft cyst (FBCC) is a rare entity of congenital anomalies in the head and neck area. Dealing with FBCC is a clinical challenge as the condition is frequently forgotten in the differential diagnosis of lateral neck swelling. We report a rare case of unilateral type I FBCC in an 11-year-old boy who presented with a painless and slow-growing preauricular mass masquerading as a benign cystic lesion of the parotid. The lesion was completely removed via surgical excision. Histopathology report confirmed the findings of squamous epithelium­lined cyst wall, which was a characteristic of a branchial cleft cyst. The combination of good clinical acumen, with the help of radiological correlation, along with a strong degree of suspicion for the condition, facilitates the diagnosis of this condition and hence proper management.

[Cystic lung diseases]. / Les maladies kystiques pulmonaires.

Cystic lung diseases present uncommonly and have an undetermined incidence. Cysts result from a broad spectrum of causative mechanisms and diseases leading to variable clinical presentations. The pathogenic mechanisms that can lead to lung cyst formation include infection, neoplastic, systemic, traumatic, genetic and congenital processes. A rigorous, systemic and multidisciplinary approach is advised in the diagnostic workup of these conditions. In this article, we review cystic lung diseases including their presentation and management.

An Unusual Case of Bilateral First Branchial Cleft Anomaly: A Case Report with Review of Literature.

We report a case of 32 year old male who presented to us with first branchial cleft anomalies on both sides with discharging cutaneous openings on the right side; and cystic swelling on the left side. High index of suspicion is required in such congenital cysts. Surgical exploration and excision is the definitive treatment of a collaural fistula.

Pediatric Bronchogenic Cysts: A Case Series of Six Patients Highlighting Diagnosis and Management.

Purpose: To present six cases of bronchogenic cysts while highlighting the diagnosis and management of this anomaly. Materials and Methods: A retrospective chart review was conducted using our institution's Pathology database. The database was queried for "bronchogenic cyst." From 2006 through 2017, six unusual cases were identified. Results: The six cases of bronchogenic cysts were located in the neck (two cases), chest wall, mediastinum (two cases), and thyroid. All six of our patients underwent complete excision and did not experience recurrence or other complications. Conclusion: Although rare, bronchogenic cysts should be considered in the differential diagnosis of peculiar cystic masses in the pediatric population. Considering the crucial regional anatomy that may be associated with bronchogenic cysts, intimate knowledge of surgical anatomy using preoperative imaging is critical in most cases for their safe and effective excision.

Large lingual heterotopic gastrointestinal cyst in a newborn: A case report.

BACKGROUND: Heterotopic gastrointestinal cysts have gastrointestinal epithelium in the cyst wall and rarely occur in the oral cavity. Most are found in the neonatal period. However, heterotopic gastrointestinal cysts that are diagnosed as a congenital tongue cyst by routine ultrasonography are extremely rare. CASE SUMMARY: A 12-day-old female presented with swelling of the anterior tongue. The obstetrician had detected significant tongue swelling on fetal ultrasonography in the 35th gestational week. The female was born by cesarean delivery at gestational week 39. She soon became dyspneic, and the cyst was aspirated. After the aspiration, her breathing recovered and she started breastfeeding. The cyst was excised under general anesthesia on the 67th day. Histopathologic examination showed that that cyst wall consisted of a lining of columnar gastrointestinal-type epithelium and pseudostratified ciliated epithelium. The patient restarted breastfeeding 3 h after surgery. The postoperative course was uneventful. CONCLUSION: Airway distress and feeding difficulty were successfully avoided by cyst aspiration, and surgical resection was performed with no perioperative complications.

A case of central diabetes insipidus associated with a congenital cyst of the sella turcica in a young cat.

CASE SUMMARY: A 1-year-old neutered male domestic shorthair cat was presented for polyuria and polydipsia which had progressed since adoption, 7 months previously. On admission, clinical examination did not reveal any remarkable features. Urinalysis showed marked hyposthenuria and calculated plasma osmolality was high, suggesting diabetes insipidus. A positive response to desmopressin administration appeared to confirm pituitary dysfunction. Brain MRI revealed a lesion compatible with a cyst or a neoplasm compressing the pituitary gland. A follow-up MRI performed 9 months later showed that the lesion was stable, which at first argued in favour of a congenital pituitary cyst. Intranasal administration of desmopressin was then used to achieve a long-term clinical response. RELEVANCE AND NOVEL INFORMATION: Central diabetes insipidus (CDI) is a rare cause of polyuria and polydipsia in cats, resulting from inadequate or impaired secretion of antidiuretic hormone from the posterior pituitary gland. Recognised causes include head trauma, central nervous system (CNS) neoplasia, idiopathic CDI and congenital pituitary cysts. Apart from one cat with CNS lymphoma, the few previously reported feline cases have described CDI in young cats with a previous history of trauma, but brain imaging has rarely been performed to look for underlying anatomical abnormalities. This report describes the first case of CDI in a cat with a confirmed congenital pituitary cyst and, as in previous cases, demonstrates successful treatment with desmopressin.

Type I pleuropulmonary blastoma presenting as congenital pulmonary airway malformation: A report of two cases.

Pleuropulmonary blastoma (PPB) is a rare aggressive intrathoracic tumor which is believed to originate from embryonic uncommitted lung mesenchymal cells, which are important for developing the lung. Type I PPB is cystic, type II is cystic and solid, while type III is predominantly solid. Diagnosing type 1 PPB is a challenge for both radiologists as well as pathologists. Owing to its purely cystic nature, type I PPB it is often mistaken for unrelated entities such as congenital pulmonary airway malformation and congenital lobar emphysema which delays surgical intervention. Here, we report two such cases presenting clinically and radiologically as congenital pulmonary airway malformation. On histology, a final diagnosis of type I pleuropulmonay blastoma was made. Thereafter, chemotherapy was administered following complete surgical excision.

An unusual rectal duplication cyst.

BACKGROUND: Rectal duplication cysts are rare gastrointestinal congenital duplicate cysts with various clinical presentations that require different management. CASE PRESENTATION: We present a case of a lady with a double rectal duplicate cyst which was found incidentally on a follow-up CT abdomen and pelvis scan. The patient initially had a mucocele excision, and following that, she had a non-contrast CT abdomen and pelvis to investigate post-operative pain. The CT scan revealed a single rectal duplicate cyst. She had a posterior approach excision to have it removed, and only intra-operatively, she was found to have a double rectal duplicate cyst. She had them both removed via a midline incision running from the perineal pigmentation and extending until the coccyx. She had another follow-up CT which showed complete excision of the cysts. CONCLUSIONS: After a thorough review of the literature regarding rectal cysts, there was no mention of a double rectal duplicate cyst. The purpose of this paper is to point out the various potential presentations of a rectal cyst as well as the idea that a double cyst is managed effectively in a similar way as the single one.

Sublingual cysts of different entities in an infant - A case report and literature review.

BACKGROUND: Congenital cysts and fistulas of the neck are common in children, often located in the head and neck area. Belonging to the group of tumor-like conditions, dermoid and epidermoid cysts are dysontogenetic lesions with seldom multiple co-occurrences in infants. CASE REPORT: We report on a nine-month-old female with a persisting congenital fistula of the tongue. The patient was admitted with acute poor feeding and hypersalivation, which started within the last 24 h. Magnetic resonance imaging detected a fistula of the tongue connected to sublingual cystic lesions. Intraoral surgical removal of three cystic lesions and the fistula was performed under general anesthesia. Histopathological analysis confirmed the coexistence of an epidermoid cyst and two dermoid cysts. CONCLUSION: Sudden feeding difficulties in combination with dysphagia and tongue displacement in pediatric patients pose an emergency situation that requires prompt diagnostic clarification. A persisting congenital fistula of the tongue is a clear indication of dysontogenetic lesions, including malformations, tumors, and tumor-like lesions. Congenital sublingual cysts are rare in infants, but can be life threatening when present. Surgical excision with histopathological analysis is essential to exclude any form of malignancy and malignant transformation.

Congenital Cyst Adenoid Malformation Masquerading as Bronchial Asthma.

Congenital cyst adenoid malformation (CCAM) is a rare congenital malformation occurring in approximately 1-4 in 100,000 births. It is classified into five subtypes with type 1 CCAM is most common subtype. The diagnosis of CCAM is usually made in infancy, and it is rare in adolescents and adults. We report a 15-year-old female, who presented in pediatric outpatient department with a history of recurrent cough since infancy. On the basis of clinical examination, provisional diagnosis of asthma was considered and patient was started on inhaled corticosteroid and long-term ß2 agonist. Lung function of the patient revealed low forced expiratory volume-1 s but without bronchodilator reversibility. Therefore, alternative diagnosis was suspected, and the patient was further evaluated with X-ray chest and high resolution computed tomography thorax. Based on radiological findings, a final diagnosis of CCAM was established. The case was highly unusual due to its atypical and late age of presentation. Acquaintance about this condition benefit clinician in making differential diagnosis of recurrent cough.

A Case of Ciliated Foregut Cyst of the Gallbladder.

Congenital cysts of the gallbladder are extremely rare, hence only a few ciliated foregut cysts of gallbladder have been reported. We report a case of a 20-year-old woman presenting with mild right upper quadrant abdominal discomfort, with normal levels of serum bilirubin and liver function tests. Abdominal ultrasonography revealed a well-defined cystic mass measured about 2 cm attached to the neck of gallbladder, with internal echogenic debris suggesting a complicated cyst, such as a hemorrhagic cyst. Abdominal computed tomography and magnetic resonance cholangiopancreatography revealed similar findings. Laparoscopic cholecystectomy showed a slightly distended gallbladder. The size of cyst on the neck was 1.6×1.2 cm, and it contained mucosa lined by ciliated pseudostratified columnar epithelium and underlying smooth muscle layers. Histopathology identified a ciliated foregut cyst of gallbladder.