The ultrasound appearance of an unusual fetal pericardial cyst.

We describe the prenatal and postnatal sonographic findings and postnatal course in the first reported patient with a posterior mediastinal pericardial cyst. We then review and discuss current knowledge about the management of prenatally diagnosed cystic structures of the pericardium. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:149-151, 2018.

Congenital Abnormalities of the Pericardium.

Congenital abnormalities of the pericardium are a rare group of disorders that include congenital absence of the pericardium, pericardial cysts, and diverticula. These congenital defects result from alterations in the embryologic formation and structure of the pericardium. Although many cases are incidentally found, they can present as symptomatic, life-threatening disease. Owing to their rarity, many cases are inappropriately diagnosed. Alterations in the embryologic formation and structure may result in the formation of these congenital abnormalities. We review the presentation, diagnosis, and management of congenital absence of the pericardium, pericardial cysts, and diverticula. A summary of multimodality imaging features is provided.

Treatment of a Fetal Tracheal Obstruction by Fetoscopy and Laser.

We report below a case of in utero tracheoscopy with laser collapse of a bronchogenic cyst obstructing the fetal trachea. The patient was referred for ultrasonography at 24 weeks of gestation because of fetal hydrops. Tracheoscopy was performed via fetoscopic approach using a single trocar under local anesthesia with lidocaine and ultrasound guidance. This revealed an image suggestive of a cyst obstructing the middle third at the anterior base of the trachea. Coagulation using a diode laser enabled us to collapse this fluid-filled cyst with three 10-watt bursts (3 times 3 s) and to visualize a completely unobstructed tracheobronchial tree with significant pulmonary fluid reflux on removal of the obstacle. The fetal condition improved markedly within 48 h after the procedure. To the best of our knowledge, this is the first described case of in utero treatment of a tracheal obstruction by tracheoscopy and laser. In severe cases of obstruction of the fetal airways, whether the obstacle is situated in a high or low position, fetal endoscopy is of diagnostic and potentially therapeutic utility.

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.

Prenatal diagnosis of mediastinal neurentric cyst with an intraspinal component.

Mediastinal neurenteric cysts are the least common types of the bronchopulmonary foregut malformations, and their antenatal diagnosis is rare. We report a case of mediastinal neurenteric cyst diagnosed on antenatal ultrasonography at 28 weeks' gestation. A small intraspinal component and vertebral segmentation anomalies were also noted. The diagnosis was confirmed on postnatal magnetic resonance imaging and at the time of operation.

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.

A rare intrapericardial enterogenous cyst presenting in infancy.

We report an infant with an intrapericardial enterogenous cyst, and discuss the differential diagnosis of intrapericardial cysts presenting in infancy.

Familial thymic cyst.

Thymic cysts are rare lesions of the anterior mediastinum or neck. The majority are asymptomatic, and the remainder are associated mainly with symptoms of dysphagia or dyspnea. Diagnosis is difficult before surgery. Cervical thymic cysts are relatively rare; age at presentation ranges from the neonatal period to adulthood, and the most frequent presenting sign is a lateral neck mass. Mediastinal thymic cysts are more common and account for 1% of all mediastinal masses. They tend to occur in the older age group and are usually detected incidentally on chest X-ray film or computed tomography scans. Dysphagia and dyspnea are the main symptoms. We describe two brothers, aged 5 and 8 years, with mediastinal thymic cysts that presented as low cervical masses and review the embryology, diagnosis and management of thymic cysts.

[Mediastinal enteric cyst: unusual clinical presentation and histopathology]. / Quiste entérico mediastínico: presentación clínica e histopatología inusuales.

A mediastinal enteric cyst is an uncommon entity which is rare in adults and usually found incidentally. In most cases the lesion is lined by gastrointestinal mucosa, and theories as to the origin of such lesions are diverse. We report an adult case of thoracic enteric cyst that presented with cardiac tamponade and for which histopathological examination revealed the presence of pancreatic tissue. Review of the literature yielded only 1 case of mediastinal enteric cyst with pancreatic tissue.

[Mediastinal esophago-bronchogenic cyst presenting as a single mass].

An abnormal shadow was found on a chest X-ray film of a 42-year-old man. The mass was 17 x 12 x 11 cm, smooth, round, homogeneous, and was seen in the left upper lung field. Chest computed tomography revealed a cystic mass in contact with the left lung, the chest wall, the esophagus, and the aorta. Magnetic resonance imaging showed a wall that divided the mass into two compartments. The cystic lesion was removed and was found to contain a yellow liquid. The larger part of the mass was histologically similar to esophageal wall and the smaller part was bronchogenic. The final diagnosis was mediastinal esophago-bronchogenic cyst. In previously reported cases, two cystic masses were connected by a canal. The findings in this case support the theory by Yoshii that this type of cyst originates from the diverticulum of the foregut near the lung bud.

Intrapericardial foregut cyst associated with intrauterine death.

Intrapericardial developmental foregut cysts are rare and are most frequently incidental findings at necropsy in adults. A 29 year old Asian woman delivered a 24 week stillborn fetus seven days after diagnosis of intrauterine death caused by rupture of a foregut cyst. Multiple cysts occupied the wall of the right atrium and its rupture caused haemopericardium and cardiac tamponade.

[A variety of mediastinal bronchogenic cyst: the broncho-alveolar cyst]. / Varietà di cisti broncogena del mediastino: cisti bronco-alveolare.

Congenital bronchogenic cysts are usually located in the mediastinum or develop as intrapulmonary cysts. Gross examination of excised bronchogenic cysts shows them to be unilocular; histologically, these lesions are characterized by the presence of respiratory-type pseudostratified epithelium as well as small islands of cartilage and seromucinous glands. We report a case of a mediastinal bronchogenic cyst having pulmonary parenchyma within the cyst wall. The rarity of our case, the pathological and clinical features and the embryological development of bronchogenic cysts are briefly discussed.

[Cervical thymic cysts. A clinical case report]. / Le cisti timiche cervicali. Presentazione di un caso clinico.

The presence of thymic residues in a laterocervical site is very rare, as is cystic degeneration. The paper reports the case of a six-year-old boy who presented a swelling in a left laterocervical site; preoperative tests (especially echography and fine needle aspiration) identified the cystic nature of the swelling which was then confirmed intraoperatively; histological test diagnosed a thymic cyst. The paper analyses the embryological, anatomopathological and clinical aspects of these formations and underlines the difficulty of making a differential diagnosis from other neck pathologies, especially branchial cysts. In conclusion, preoperative tests can only determine the cystic component but not the thymic origin of these formations which can only be confirmed by final histological tests.

Benign neoplasms and cysts of the mediastinum.

Benign neoplasms and cysts are the most common tumors of the mediastinum. However, they are still an infrequent clinical entity. Their diagnosis has been aided by the recent advances in CT scanning, MRI, ultrasonography, radionucleotide scanning, and fine-needle aspiration. The treatment of these benign tumors in children and the majority of adults is excision. In asymptomatic adults, observation or fine-needle aspiration and observation may be considered for pericardial cysts and selected neurogenic tumors and bronchogenic cysts.

Foregut cysts of the mediastinum. Results in 20 consecutive surgically treated cases.

Mediastinal cysts of foregut origin represent an important diagnostic group. Classified according to their anomalous embryonic origins, they include bronchogenic, esophageal, enteric, and nonspecific cysts. A series of 20 consecutive surgically treated cases from the thoracic surgical service of a large medical center is reported, all successfully resolved without mortality. Described are 12 bronchogenic, four enterogenous, and four nonspecific cysts, occurring in a variety of thoracic locations. Close attention to symptomatology reveals a wide range of manifestations, from total absence of symptoms to life-threatening respiratory distress. Definitive diagnosis was accomplished in some cases by means of noninvasive radiologic techniques, while angiography, bronchoscopy, and esophagoscopy were also useful in selected instances. Operative therapy consisted of complete excision if possible or partial excision if adhesion to intrathoracic bodies had occurred.

Cervical thymic cyst: case report and review of literature.

An unusual case of a cervical thymic cyst in a 4-year-old boy is presented. The embryology, histopathology, and clinical presentation is discussed. This entity should be included in the differential diagnosis of cystic neck masses in the pediatric age group.