Mediastinal Thoracic Duct Cyst – An Unusual Finding

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Large pancreatic pseudocyst penetrating into posterior mediastinum.

We report a rare case of a large mediastinal pancreatic pseudocyst compressing the left atrium and the esophagus and causing dyspnea, palpitations, and emesis. Chest radiograph was non-diagnostic, esophagogastroduodenoscopy showed diffuse extrinsic compression of the distal esophagus and gastric corpus, but a definitive diagnosis was confirmed by computed tomography. We decided to perform surgery due to the recurrence of the pancreatic pseudocyst, a history of unsuccessful radiologically guided external drainage a few years earlier, and a very large diameter of the pseudocyst causing acute cardio-pulmonary distress syndrome.

Scintigraphic Identification of Gastric Tissue in a Mediastinal Mass.

We present a Tc pertechnetate scintigraphy performed in a 64-year-old woman to investigate a mediastinal cystic mass in search of residual gastric mucosa after gastrectomy. She had a history of esophagectomy and gastric pull-up for esophageal cancer. Postoperative leakage necessitated ablation of the gastric pull-up and reconstruction using part of the colon. Oral realimentation resulted in mediastinal pain and brownish discharge within the trachea, raising the suspicion of residual gastric pouch. SPECT/CT demonstrated increased tracer uptake in the median part of the mediastinal cyst, and a biopsy confirmed the presence gastric mucosa.

Thymic lymphoid hyperplasia with multilocular thymic cysts diagnosed before the Sjögren syndrome diagnosis.

BACKGROUND: Thymic lymphoid hyperplasia is often present with myasthenia gravis as well as other autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis. Of the 4 cases of thymic lymphoid hyperplasia associated with Sjögren syndrome that have been reported, no case with a thymic lesion diagnosis that led to the diagnosis of Sjögren syndrome has been reported. We herein report a case of thymic lymphoid hyperplasia with multilocular thymic cysts, diagnosed before Sjögren syndrome. CASE PRESENTATION: A 37-year-old Japanese woman had an approximate 5-cm anterior mediastinal mass detected by chest imaging. The resected lesion revealed multilocular thymic cysts that were filled with colloid-like material. Histology showed lymph follicular hyperplasia with many epithelial cysts. The epithelium consisted of thymic medullary epithelium, and no epithelial proliferation was seen in the lymphoid tissue. Lymphocytes were composed of an organized mixed population of mature T and B cells without significant atypia. The infiltrated B cells did not reveal light chain restriction or immunoglobulin heavy chain gene rearrangement. After the pathological diagnosis of thymic lesion, tests for the presence of autoantibodies were positive for antinuclear antibodies, rheumatic factor, and anti-SSA/Ro antibodies. The Schirmer's, chewing gum, and Saxon tests showed decreased salivary and lacrimal secretion. Lip biopsy showed focal lymphocytic sialadenitis. The signs and symptoms of Sjögren syndrome had not resolved, without aggravation, 1 year after the thymectomy. CONCLUSION: When a case with thymic lymphoid hyperplasia without myasthenia gravis is encountered, it is essential to consider the presence of another autoimmune disease including Sjögren syndrome.

Posttraumatic pericardial cyst.

Pericardial cysts are uncommon lesions usually found incidentally upon the radiologic investigation of some other condition. The aetiology can be both congenital and acquired (post inflammatory processes, infection or even posttraumatic). They are the most common benign tumour of the pericardium but there is still a difficulty in the differential diagnosis because even clinical or analytically are not different from some other benign or malignant lesions. Further image studies are required to complete the study of these lesions. Even the majority are asymptomatic (>50%), the localization and relation to adjacent structures lead the role of the clinical manifestations (persistent cough, dyspnoea, chest pain...). We present the case of a man with oppressive chest pain after 2 weeks of thoracic traumatism with an abnormal radiological image in the chest X-ray.

Fate of traumatic pulmonary pseudocyst: factors of resolution.

BACKGROUND: Traumatic pulmonary pseudocysts are rarely talked about, developing in less than 3% of patients with pulmonary parenchymal injuries. Resolution usually occurs within a few weeks to a few months. METHOD: A prospective study was undertaken in 21 cases treated in Menoufia University Hospital, Egypt from August 2011 through August 2013. RESULTS: The overall mean time for complete resolution was 61.1 days. The mean time for resolution of simple traumatic pulmonary pseudocysts was 21 days (n = 6), and the mean time for resolution of complicated (blood filled) traumatic pulmonary pseudocysts was 77.1 days (n = 15). Mean resolution time was 26.3 days for small pulmonary pseudocysts ≤22 mm (n = 11) and 99.4 days for those >22 mm (n = 10). The resolution time was 42.6 days in patients 17-years old or younger (n = 11) and 81.4 days in patients older than 17 years (n = 10). CONCLUSION: There was a highly significant difference in resolution time between simple and complicated pseudocysts. There was also a highly significant delay in the resolution time of pseudocysts larger than 22 mm and in patients older than 17 years.

Pericardial cyst in a 2-year-old Maine Coon cat following peritoneopericardial diaphragmatic hernia repair.

A pericardial cyst developed in a 2-year-old male neutered Maine Coon cat following surgery for an incidentally diagnosed congenital peritoneopericardial diaphragmatic hernia. The cyst caused no clinical signs in the cat, although clinical findings included positional right-sided cardiac tamponade and compression of thoracic structures, associated with a cardiac arrhythmia and axis deviation on electrocardiography. Extensive assessment of the cyst included radiography, echocardiography, computed tomography, exploratory thoracotomy, electrocardiography, histopathology and fluid analysis. Surgical removal of the cyst was curative, and the arrhythmia and axis deviation resolved. This report details case management from initial diagnosis to long-term follow-up, adding to the limited body of literature available on feline pericardial cysts. This is also the first report to associate cardiac arrhythmia with a pericardial cyst.

[Cystic lesion in the topography of occluded aortocoronary saphenous vein bypass]. / Zmiana torbielowata w topografii niedroinego, zylnego pomostu aortalno-wiencowego.

Article presents a case of a 66-year old manwith a pericardial cyst, localized in tlhe topography of an occluded aorto-ccoronary saphenous vein graft. The lesion was revealed in computed tomogrnaphy and also evaluated in the subsequently performed magnetic resonance.

Alcohol ablation of pericardial cysts under pericardioscopical control.

Pericardial cysts are rare. They are often asymptomatic mediastinal abnormalities, which are usually congenital. If symptomatic differential diagnosis can pose a diagnostic challenge since it has to consider the different causes of pericardial effusion including malignant forms. In 2 symptomatic female patients (aged 51 and 58 years) pericardiocentesis, pericardioscopy and pericardial fluid analysis confirmed the diagnosis of "spring water cysts." Pericardioscopy excluded protrusions, petechial bleeding, neovascularization or inflammation. Application of contrast media into the cyst confirmed by radiological control that no communication to the true pericardial sac was present. So after aspiration of the entire fluid, subsequent instillation of 10 ml ethanol for a few minutes was carried out to prevent recurrence of the cystic formation. The aspiration of the residual fluid under moderate suction demonstrated and 24-h clinical observation at the ICU completed the short intervention. All symptoms were relieved immediately in both patients. Recurrence was not observed in the follow-up.

[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.

[Multilocular thymic cyst associated with rheumatoid arthritis].

A 66-year-old woman had been receiving treatment for rheumatoid arthritis( RA) since her 28 years of age. Chest computed tomography( CT) taken during follow-up showed an anterior mediastinal tumor of 35×20×65 mm in size as a region of heterogeneous internal density. Accumulation of 18F-fluorodeoxyglu cose was identified on positron emission tomography( PET)[ maximum standardized uptake value( SUV max) 8.7]. Thymic epithelial tumor( thymoma or thymic cancer) with cystic degeneration was initially suspected, so total thymectomy was performed. A multilocular, non-invasive tumor mass was completely resected. Pathological diagnosis was lymphoid follicular hyperplasia with concomitant multilocular thymic cyst( MTC). Surgery resulted in alleviation of RA symptoms and a decreased inflammatory response. Inflammation due to autoimmune disease is believed to play an important role in the formation of MTC. In the present case, surgery may have inhibited the progression of RA.

Mediastinal extension of pancreatic pseudocyst--a case with review of topic and management guidelines.

Pancreatic pseudocyst is a common complication of acute and chronic pancreatitis. Extension of a pancreatic pseudocyst into the mediastinum is rare. We present a case of a 43-year-old male with a history of pancreatitis, who presented with dysphagia and was found to have a pancreatic pseudocyst. The pseudocyst was extending to the mediastinum and compressing the esophagus. It was successfully drained externally by computed tomography-guided catheter intervention. Depending on the location and size, patients may present with dyspnea, chest pain, palpitations, or dysphagia; sometimes with hemoptysis, acute respiratory compromise, or cardiogenic shock. There are no recommended guidelines for management. Watchful waiting for spontaneous regression, medical therapy, or drainage internally or externally with endoscopic, percutaneous, or open surgical approach are available options. Based on our own experience and literature review of such cases, we present a management strategy that can limit both complications and recurrence rate. This case emphasizes the importance of the possibility of mediastinal extension of a pancreatic pseudocyst and provides reference guidelines to approach the same.

Paramediastinal air cyst with traumatic bronchial injury: a rare complication of neonatal resuscitation.

Paramediastinal air cysts and pneumatoceles are known complications of chest trauma and mechanical ventilation. After an initial period of enlargement, these lesions tend to resolve completely with conservative management. We present a case of a premature newborn who developed an enlarging paramediastinal air cyst as a result of resuscitation around the time of delivery that ultimately required surgical excision via a right thoracotomy. To our knowledge, this is the first reported case in a neonate.