Infected Congenital Epicardial Cyst Presenting as Acute Abdomen.

A previously healthy 3-year-old boy presented to the emergency department with abdominal pain, fever, and emesis. Laboratory and radiologic evaluation for causes of acute abdomen were negative; however, review of the abdominal x-ray demonstrated cardiomegaly with the subsequent diagnosis of pericardial cyst by echocardiogram and computed tomography. The patient underwent surgical decompression and attempted removal of the cystic structure revealing that the cyst originated from the epicardium. His abdominal pain and fever resolved postoperatively and he completed a 3-week course of ceftriaxone for treatment of Propionibacterium acnes infected congenital epicardial cyst. Emergency department physicians must maintain a broad differential in patients with symptoms of acute abdomen to prevent complications from serious cardiac or pulmonary diseases that present with symptoms of referred abdominal pain.

Congenital cystic neck mass of thymic origin.

Neck masses are frequently seen in children. The differential diagnosis includes infectious, congenital and neoplastic lesions. We report a case of rare thymic neck mass in a boy in his middle childhood presented with a history of a left anterolateral neck mass not associated with fever, dysphagia or shortness of breath. The radiographic evaluation showed a picture of a thymopharyngeal duct cyst. Thymic remnant and thymopharyngeal duct cyst are caused by the failure of obliteration and might appear as a lateral neck mass in children. The most effective treatment for a thymopharyngeal duct cyst is total surgical excision. This particular case highlights the importance for clinicians to have a high index of suspicion for a broad differential diagnosis when evaluating paediatric patients who present with neck mass. Additionally, we emphasise the importance of consistently considering thymopharyngeal cyst as differential diagnosis.

Congenital pericardial cyst in a naval special warfare candidate; clearance for diving after resection.

INTRODUCTION: We report the case of a 19-year-old male military recruit who presented for a screening physical for U.S. Naval Special Warfare and Diving Duty. During his screening physical examination, an exophytic pericardial cyst was discovered. Subsequent work-up revealed normal cardiopulmonary function despite this large 7-cm mass, but the candidate was disqualified due to concerns regarding the risk of complications. He underwent successful elective surgical resection without post-operative complications. One year post-operatively, he repeated his cardiopulmonary work-up with normal results and successfully completed training. METHODS: Literature search was conducted using PubMed/Medline. Keywords included pericardial/um, cyst, mediastinum, special operations, military, diving, thoracoscopy/ic resection. Results that included cases of pericardial cysts or other mediastinal tumors were included. RESULTS: Review of the literature reveals that complications are rare and range widely in severity. Analysis of the physiology of diving, together with absence of reported cases, suggest that there is little to no, increased risk in recreational scuba diving for subjects with asymptomatic lesions. While no cases of morbidity or mortality have been reported in elite athletes, the severe and repetitive trauma experienced by Special Operators raises clinical concern for these lesions. CONCLUSION: Because of the increased risk of morbidity and mortality in the Special Operations environment, clearance for duty should not be granted those individuals. However, in the general population, as well as with low-impact activities such as recreational scuba diving, periodic observation without resection seems reasonable.

Large cervicothoracic thymic cyst causing prominent airway deviation in a 3-day-old neonate.

Cervicothoracic mass in the pediatric population is uncommon and has a broad differential diagnosis. Frequently, masses in the cervical region present with airway compromise, particularly in younger patients. We present a case of an extremely large cervicothoracic mass causing airway obstruction in a 3-day-old, otherwise healthy male infant. Following awake intubation for airway protection, a 4.5 cm x 2.5 cm x 1.5 cm thymic cyst was removed. This case illustrates the wide differential diagnosis of cervicothoracic masses and shows the difficulty of preoperative diagnosis, especially in the case of thymic cysts with extension into the cervical space.

[The cysts and fistulas of the neck in material of Otolaryngology Department of Rydygier District Hospital in Cracow]. / Torbiele i przetoki szyi w materiale oddzialu Otolaryngologii Wojewódzkiego Szpitala Specjalistycznego im L. Rydygiera w Krakowie w latach 1997-2007.

The retrospective study describes 118 patients treated for congenital cysts and fistulas of the neck between 1997 and 2007 in ORL Department of Rydygier District Hospital in Cracow. Malformation was divided into midline and laterocervical region anomalies. Malformation of midline included thyreoglossal duct and dermoid cyst. The most common malformation of laterocervical were cysts followed by fistulas. The theory of development, method of diagnosis and operative management were presented. Complication and recurrences were rare. Proper differential diagnosis and radical operation led to successful cure.

Congenital neck masses in children and their embryologic and clinical features.

Congenital neck masses in children and their embryologic and clinical features. Neck masses of congenital origin can be diagnostic and therapeutic challenges for internists, paediatricians and surgeons. Treatment modalities of congenital neck masses are different depending on their nature, symptoms and location. Differential diagnosis includes a variety of diseases that can cause cervical masses such as infectious and neoplastic neck tumours. Our objective is to review the embryologic and clinical features of some of the most common congenital neck masses such as the haemangioma, branchial cleft anomalies, thyroglossal duct cyst, ectopic thyroid, congenital midline cervical cleft, congenital cervical teratoma, lymphangioma, cervical thymic cyst, dermoid cyst and congenital muscular torticollis.

Mediastinal foregut duplication cyst presenting as a rare cause of breathing difficulties in an adult.

Foregut duplication cysts are rare congenital anomalies of enteric origin. The diagnosis is usually made in infancy. We report the unusual case of a 71-year-old female presenting to the ENT department with shortness of breath and stridor due to an oesophageal reduplication cyst. The presentation, diagnosis and management of this potential pitfall for the unwary are outlined.

Foregut duplication cyst: a novel computed tomography finding mimicking a small bowel hernia: A case report.

RATIONALE: A foregut duplication cyst (FDC) is an uncommon congenital disease. This report presents a case of mediastinal foregut duplication cyst that mimicked a diaphragmatic small bowel hernia. PATIENT CONCERN: A 27-month-old girl was first referred for a mediastinal lesion found incidentally on a chest radiograph. At that time, our impression was cystic lung lesion such as congenital pulmonary airway malformation or pulmonary sequestration. At the age 6 years, she presented with recurrent vomiting. The physical examination and laboratory studies were within normal limits. DIAGNOSES: Chest CT revealed a thin- and smooth-walled cystic mass containing an air-fluid level in the left paravertebral space. It had several inner circular folds and characteristic double-layer enhancement and inner circular fold. Our radiological impression was a type I congenital cystic adenomatoid malformation. INTERVENTIONS: The patients undergone video-assisted thoracoscopic surgery for excision. The operative finding was the cystic mass with smooth bowel-like outer surface and located between the aorta and heart. The cyst was excised and confirmed to be a foregut duplication cyst pathologically. OUTCOMES: The patient was doing well with no postoperative complications during follow-up. Recurrent vomiting was improved. This is the first case report describing foregut duplication cyst mimicking a small bowel hernia. LESSONS: Foregut duplication cysts are rare congenital anomalies of primitive foregut origin. They can occur at any level of the alimentary track and comprise approximately 10% of all mediastinal tumors. Its characteristic double-layered histopathological nature, an FDC can show a double-layered enhancement pattern, which is typical in the alimentary tract.

Inflammation and Rupture of a Congenital Pericardial Cyst Manifesting Itself as an Acute Chest Pain Syndrome.

We present the case of a 63-year-old woman with a remote history of supraventricular tachycardia and hyperlipidemia, who presented with recurrent episodes of acute-onset chest pain. An electrocardiogram showed no evidence of acute coronary syndrome. A chest radiograph revealed a prominent right-sided heart border. A suspected congenital pericardial cyst was identified on a computed tomographic chest scan, and stranding was noted around the cyst. The patient was treated with nonsteroidal anti-inflammatory drugs, and the pain initially abated. Another flare-up was treated similarly. Cardiac magnetic resonance imaging was then performed after symptoms had resolved, and no evidence of the cyst was seen. The suspected cause of the patient's chest pain was acute inflammation of a congenital pericardial cyst with subsequent rupture and resolution of symptoms.

Gross mural cartilage in a congenital bronchogenic cyst: MRI features.

An infant who had a cardiac murmur after the delivery was evaluated with echocardiogram. A 1 cm cystic area was incidentally identified in the upper right mediastinum, that was not related with the heart. A 4 x 4.5 x 8 cm cystic mass in the superior mediastinum and lower neck was demonstrated on the magnetic resonance imaging (MRI). At surgery, a small solid structure corresponding to the nodule seen on MRI was identified, which was firm and cartilaginous in nature and attached to the wall of the cyst. Grossly visible cartilage in association with a bronchogenic cyst has not been previously reported. In conclusion, the bronchogenic cysts can have grossly visible cartilage in their wall and extend to extrathoracic spaces in a contiguous fashion, mimicking other entities such as teratomas and cystic lymphangiomas.

An unusual cause of stridor in an adult: mediastinal foregut duplication cyst.

We present a case of unusual presentation of stridor in an adult man who was identified to have a sudden expansion of a foregut duplication cyst in the mediastinum. This resulted in superior vena caval obstruction and subsequent airway compromise. Following resuscitation, the cyst was surgically removed via a thoracotomy which confirmed the diagnosis and provided definitive management. Foregut duplication cysts are an unusual cause of stridor in adults, with only five cases ever documented worldwide in the literature, presenting in such a manner. This case is a reminder of the importance of thorough clinical examination, the benefits of radiology as an indispensible adjunct and essential role of the multidisciplinary team.

Clinical spectrum of mediastinal cysts.

OBJECTIVES: Congenital cysts of the mediastinum are an uncommon but important diagnostic group, representing 12 to 30% of all mediastinal masses. The purpose of this study was to review our institutional experience with congenital cysts of the mediastinum, emphasizing the clinical spectrum of the disease. DESIGN: Retrospective study. OBJECTIVES: University hospital unit of general thoracic surgery. METHODS: We retrospectively reviewed the records of 105 patients with cysts of the mediastinum (50 male and 55 female patients) who comprised 13.0% of mediastinal masses over the past 50 years. RESULTS: There were 10 pediatric patients (< 15 years old) and 95 adult patients. The prevalence of cysts in the adult populations was higher than that in children (14.1% vs 7.7%, p < 0.05). There were 47 bronchogenic cysts, 30 thymic cysts, 12 pericardial cysts, 7 pleural cysts, 4 esophageal duplications, 2 meningoceles, 1 thoracic duct cyst, and 2 others. MRI has become a useful tool for providing supplemental data in combination with CT. Overall, 38 patients (36.2%) with mediastinal cysts were symptomatic, including 39.2% with bronchogenic/esophageal cysts, 40% with thymic cysts, and 15.8% with pericardial/pleural cysts. One hundred patients had complete resection of their masses, 3 patients with pericardial diverticulum received a thoracoscopic fenestration without mortality, and 2 patients refused surgery. CONCLUSION: Early recognition of these relatively rare lesions would lead to immediate and appropriate surgical intervention. Early surgical intervention is also important because definitive histologic diagnosis can only be established by means of surgical extirpation.

Bronchial atresia associated with a bronchogenic cyst. Evidence of early appearance of atretic segments.

We report a case of congenital lobar emphysema in an adult due to bronchial atresia and presenting characteristically with a solitary pulmonary nodule due to a mucous plug. In the same patient the presence of a bronchogenic cyst leads to a hypothesis that the atretic segment is the result of an insult occurring during the 5th or 6th week of intrauterine life rather than one occurring after airway development is complete.

Giant pericardial cysts.

Pericardial cysts are most commonly incidental radiologic findings of little clinical consequence. We present the unusual history of 2 patients in whom pericardial cysts were of massive sizes and caused significant symptoms; in 1, progression of the cyst size had been documented over 25 years. Diagnostic difficulties encountered and the utility of video-assisted thoracoscopy are described.

Endoscopic unroofing of a bronchogenic cyst.

Flexible fiberoptic bronchoscopy (FFB) has become common practice for pediatric pulmonologists, allowing easier detection of certain abnormalities at an earlier stage. We report the endoscopic diagnosis of a large mediastinal bronchogenic cyst and its successful endoscopic unroofing in a symptomatic baby.

Mediastinal bronchogenic cyst treated by mediastinoscopic drainage.

Bronchogenic cysts are rare congenital anomalies located in the mediastinum and lung parenchyma. We present the clinical findings and describe the mediastinoscopic treatment of a bronchogenic cyst at the subcarinal space in a 50-year-old man. CT revealed a lesion at the subcarinal space with soft tissue density. Initially, mediastinoscopy was performed for diagnostic purposes. Histopathological evaluation of biopsy material taken from the cyst wall confirmed that the lesion was a bronchogenic cyst. The cyst contents were drained and a sclerosant agent was applied to the cyst lumen via the drainage tube. Mediastinoscopy not only provides diagnostic information but can also be used safely in the treatment of anterior bronchogenic cysts in patients not amenable to a second operation.

Concurrent cysts of the mediastinum, pleura and neck.

A 14-year-old male was found to have a mediastinal mass on chest radiograph. Chest computed tomography scans showed a cystic lesion behind the left main bronchus. Magnetic resonance imaging revealed additional cystic lesions in the left chest and root of the neck. He underwent excision of mediastinal mass and a pleural cyst. The neck lesion was presumed to be a cystic hygroma. Histological examination of the two lesions resected showed them to be a foregut cyst and a benign mesothelial cyst. We know of no other report of concurrent multicystic lesions in the chest and neck and hypothesize that these cysts may have a common embryonic origin.

[Bronchogenic cysts of the upper mediastinum]. / Bronchogene Zyste des oberen Mediastinums.

A case report of a congenital bronchogenic cyst in the upper mediastinum on the level of the thoracic aperture, which very likely communicates with the oesophagus, is presented. The embryogenesis, aetiopathogeny, diagnostics, location and histological structure of this rare case are discussed.

Hemithyroid agenesis associated with a cervical thymic cyst.

A case is presented of a 7-yr-old boy with left hemithyroid agenesis associated with cervical thymic cyst. No left parathyroid glands were found. The diagnosis was established after surgical excision and histologic examination. Clinical and embryological implications of this condition are briefly discussed. No similar case has been found in the literature.