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.

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.

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.

Achado Radiológico de Cisto Pericárdico / Radiologic Finding of Pericardial Cyst

Mulher de 46 anos de idade, em acompanhamento porinfecção cutânea por Bukhoderia pseudomallei em membrosuperior esquerdo, realizou radiografia de tórax para descartaracometimento pulmonar, que evidenciou hipotransparênciaem lobo inferior esquerdo (Figura 1A). Posteriormente, foisubmetida a tomografia de tórax que demonstrou coleçãolíquida, sem realce pelo meio de contraste, medindo 8cm no maior eixo axial, ocupando o seio cardiofrênicoesquerdo (Figura 1B). O ecocardiograma transtorácico (ECO)mostrou função sistólica preservada (FE 62% pelo Teichholz),espessamento pericárdico discreto e cisto pericárdico emregião posterior e em ponta do coração, contendo traves defibrina (Figura 2). Posteriormente, a paciente foi submetidaa drenagem percutânea do cisto guiada por US (citologia:hemácias 0, leucócitos 1.000, 60% mononucleares e 40%neutrófilos; cultura negativa). O ECO realizado um mês apósa drenagem demonstrou discreto espessamento pericárdico(4 mm) e ausência de derrame pericárdico. Paciente segueem tratamento ambulatorial com o infectologista.Cistos pericárdicos são anomalias congênitas raras egeralmente benignas. Representam 6% das massas mediastinaise 33% de todos os cistos do mediastino. A grande maioriados cistos é assintomática e geralmente é achado incidentalem exames de imagens que podem ser confundidos comaneurisma da artéria coronariana, neoplasias e pneumonia.Complicações como a ruptura do cisto, compressão cardíacae até mesmo morte súbita já forma descritas, porém sãoincomuns. Pode-se adotar uma conduta conservadora emcasos assintomáticos desde que seja possível o seguimentodo paciente, de forma a garantir um curso benigno em que ocisto pericárdico pode involuir espontaneamente...

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.

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.

Congenital cystic neck masses: embryology and imaging appearances, with clinicopathological correlation.

Congenital cystic masses of the neck are uncommon and can present in any age group. Diagnosis of these lesions can be sometimes challenging. Many of these have characteristic locations and imaging findings. The most common of all congenital cystic neck masses is the thyroglossal duct cyst. The other congenital cystic neck masses are branchial cleft cyst, cystic hygroma (lymphangioma), cervical thymic and bronchogenic cysts, and the floor of the mouth lesions including dermoid and epidermoid cysts. In this review, we illustrate the common congenital cystic neck masses including embryology, clinical findings, imaging features, and histopathological findings.

Double esophageal duplication cysts, with ectopic gastric mucosa: a case report.

Esophageal duplication cyst (EDC) is a congenital malformation of the posterior primitive foregut, which mainly occurs in the thoracic esophagus. Here, we describe a 3-year-old Han Chinese boy afflicted with intermittent fever of acute onset and dry cough. Thoracic computed tomography revealed an 10 cm × 5.4 cm × 5.8 cm oval-shaped, cyst-like tumor located in the extrapleural space, extending along the right paravertebral gutter and compressing the trachea forward. An additional small-sized, oval-shaped cyst was identified in the posterior mediastinum, between the esophagus and the spinal column, at the T1 level. During open thoracotomy, under general anesthesia, an opaque, thick-walled, esophageal cyst was revealed not to be in communication with the esophageal lumen or the trachea. This cyst was subsequently resected in an en bloc manner. The small (1-cm) esophageal cyst was left untreated based on a "wait-and-see" policy. Histological analysis showed that the resected cyst was walled by hyperplastic, fibrous tissues and locally lined with gastric mucosa inherent glands. This finding was consistent with a diagnosis of EDC, with ectopic gastric mucosa. The respiratory tract symptoms resolved immediately after the operation. Computed tomography obtained at the 6-month follow-up showed that no disease, residual or recurrence, was present after the resection of the large-sized cyst, and the small-sized cyst remained unchanged in size.

[Benign cysts of the mediastinum: series of 28 cases]. / Les kystes bénins du médiastin : à propos de 28 cas.

INTRODUCTION: Benign cystic mediastinal mass form a group of heterogeneous and uncommon lesions. Surgical resection is the gold standard in these conditions. We reported our institutional experience in management of these benign tumours. In this review, cardiac and ganglionary benign mass were excluded. METHODS: We retrospectively reviewed the records of 28 patients with benign cysts of the mediastinum, who are operated in our department between January 2003 and December 2009 (7years period). RESULTS: There were 13 females (46.4%) and 15 males (53.5%), with a mean age of 36.8years (range: 13-63years). Most lesions (n=22) were equally in the anterior and middle mediastinum, only six were in the posterior mediastinum. Seventeen patients (60.7%) were symptomatic, with chest pain and cough as the most common symptoms. The diagnosis of mediastinal cyst was fortuitous in 11 patients with the waning of an assessment made for another reason. Surgery was indicated in all patients in order to both diagnostic and therapeutic. Posterolateral thoracotomy incision is the most common. Complete resection of the cyst was possible only in 18 cases (64.3%), whereas in ten (35. 7%) other cases part of the cyst was left in place due to tight adhesions to vital structures. After histological study, there were: nine bronchogenic cysts (32.1%), seven hydatid cysts (25%), four cystic lymphangiomas (14.3%), three mature cystic teratomas (10.7%) and three pleuropericardial cysts, one thymic cyst and one parathyroid cyst. The postoperative course was uneventful and no recurrence has been observed until now. CONCLUSION: The benign cysts of the mediastinum is a rare entity, the hydatid etiology remains common in our context. Surgical treatment remains the treatment of choice for mediastinal cysts, when the patient is operable, to save the risk of complications or degeneration.