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Alrashidi I, Shin JH. Percutaneous Transhepatic and Translumbar Sclerotherapy of a Thoracic Duct Cyst: A Case Report. THE ARAB JOURNAL OF INTERVENTIONAL RADIOLOGY 2021. [DOI: 10.1055/s-0041-1730116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractA 58-year-old male presented with chronic abdominal pain lasting 5 years and a 15 × 6-cm multicystic thoracic duct cyst with three compartments, located in the right retrocrural and retrocardiac regions from T5/T6 to T12/L1. A transhepatic route was selected to sclerose the middle and lower compartments. Subsequent contrast injection showed minimal contrast passage into the upper compartment through a narrow neck, but the guidewire could not pass into this compartment. The contrast-filled upper compartment was punctured with a 22-g Chiba needle using a translumbar approach under cone-beam computed tomography (CT) guidance and ethanol sclerotherapy was performed. Six-month follow-up CT revealed decreased thoracic duct cyst size (5×3 cm) and no pain. This case illustrates successful percutaneous transhepatic and translumbar sclerotherapy for retrocardiac and retrocrural thoracic duct cysts, which are very difficult to remove surgically.
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Affiliation(s)
- Ibrahim Alrashidi
- Department of Radiology, University of Ulsan, College of Medicine Asan Medical Center, Songpa-gu, Seoul, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology, University of Ulsan, College of Medicine Asan Medical Center, Songpa-gu, Seoul, Republic of Korea
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Talmor G, Nguyen B, Mir G, Badash I, Kaye R, Caloway C. Sclerotherapy for Benign Cystic Lesions of the Head and Neck: Systematic Review of 474 Cases. Otolaryngol Head Neck Surg 2021; 165:775-783. [PMID: 33755513 DOI: 10.1177/01945998211000448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The role of sclerotherapy for vascular lesions of the head and neck is well established. However, the efficacy of sclerotherapy for benign cystic lesions of the head and neck is less clear. The objective of this review is to determine the efficacy and safety of sclerotherapy for benign cystic lesions of the head and neck. DATA SOURCES PubMed/MEDLINE, Cochrane Library, and Embase. REVIEW METHODS The PRISMA guidelines (Preferred Reporting Systems for Systematic Reviews and Meta-analyses) were followed for this systematic review. Studies of patients with benign head and neck cystic masses treated primarily with sclerotherapy were included. Thirty-two studies met criteria for inclusion. RESULTS A total of 474 cases of sclerotherapy were reviewed. Agents comprised OK-432, ethanol, doxycycline, tetracycline, and bleomycin. Lesions in the analysis were ranula, thyroglossal duct cyst, branchial cleft cyst, benign lymphoepithelial cyst, parotid cyst, thoracic duct cyst, and unspecified lateral neck cyst. A total of 287 patients (60.5%) had a complete response; 132 (27.9%) had a partial response; and 55 (11.6%) had no response. OK-432 was the most widely utilized agent, with a higher rate of complete response than that of ethanol (62.0% vs 39.4%, P = .015). Fifty-three cases (11.2%) required further surgical management. One case of laryngeal edema was reported and managed nonoperatively. CONCLUSION Sclerotherapy appears to be a safe and efficacious option for benign cystic lesions if malignancy is reliably excluded. Efficacy rates are comparable to those of sclerotherapy for vascular malformations. The rate of serious complications is low, with 1 incident of airway edema reported in the literature.
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Affiliation(s)
- Guy Talmor
- Department of Otolaryngology-Head and Neck Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Brandon Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Ghayoour Mir
- Department of Otolaryngology-Head and Neck Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Ido Badash
- Caruso Department of Otolaryngology-Head and Neck Surgery, University of Southern California, Los Angeles, California, USA
| | - Rachel Kaye
- Department of Otolaryngology-Head and Neck Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Christen Caloway
- Department of Otolaryngology-Head and Neck Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
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Abelardo E, Shastri P, Prabhu V. Variations in the Management of Cervical Thoracic Duct Cyst. Biomed Hub 2020; 5:7-14. [PMID: 32775334 DOI: 10.1159/000507275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 03/17/2020] [Indexed: 11/19/2022] Open
Abstract
We present an uncomplicated case report of a cervical thoracic duct cyst (CTDC) in a 61-year-old woman treated with surgical excision. We reviewed 47 similar cases since it was first described in 1964 and evaluated the different diagnostic and management approaches. Previously believed to be the gold standard tool for evaluation, lymphangiography is now less popular due to advent of high-resolution imaging combined with aspiration techniques. CTDC treatment includes observation, low-fat diet, repeated aspirations, external pressure, sclerotherapy, embolisation, and surgical intervention. The preferred management of choice to date is surgical excision.
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Affiliation(s)
- Edgardo Abelardo
- ENT Department, Hywel Dda University Health Board, Carmarthen, United Kingdom
| | - Priyanka Shastri
- ENT Department, Hywel Dda University Health Board, Carmarthen, United Kingdom
| | - Vinod Prabhu
- ENT Department, Hywel Dda University Health Board, Carmarthen, United Kingdom
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Gao HJ, Gong L, Jiang ZH, Wei YC, Ma K. A tension tracheal diverticulum: recurrence after interventional sclerotherapy followed by transcervical resection. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:12. [PMID: 30788359 DOI: 10.21037/atm.2018.11.35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Tracheal diverticulum is a rarely congenital or acquired tracheal benign entity, characterized by round or spherical out-pouching of the tracheal wall. Most of the tracheal diverticula are asymptomatic disease, and therefore surgical treatment has not been widely reported. Symptomatic diverticula can accept conservative treatment such as anti-inflammatory, postural drainage, etc. Transcervical resection or endoscopic laser surgery or electrosurgery should be considered for patients with severe symptoms or combined with repeated tracheobronchial inflammation. However, there is still insufficient evidence to recommend the optimal therapeutic schedule at present. We describe a special tension tracheal diverticulum with rare symptoms of dysphagia and dizziness for the first time which has a recurrence after interventional sclerotherapy followed by transcervical resection.
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Affiliation(s)
- Hui-Jiang Gao
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Lei Gong
- Department of Esophageal Cancer, Tianjin's Clinical Research Center for Cancer and Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300000, China
| | - Zhi-Hui Jiang
- Department of General Surgery, Qingdao Women and Children's Hospital, Qingdao 266000, China
| | - Yu-Cheng Wei
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
| | - Kai Ma
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, China
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Bhalla V, Schrepfer T, McCann A, Nicklaus P, Reading B. Spontaneous retropharyngeal and mediastinal thoracic duct cyst in an infant with respiratory distress. Int J Pediatr Otorhinolaryngol 2018; 105:33-35. [PMID: 29447814 DOI: 10.1016/j.ijporl.2017.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/16/2017] [Accepted: 11/18/2017] [Indexed: 11/16/2022]
Abstract
Thoracic duct cysts (TDC) within the retropharyngeal space and mediastinum are exceedingly rare lesions, with the majority related to trauma or neoplasm. We describe a case of an otherwise healthy 8-month-old boy who presented with severe respiratory distress, which was found to be caused by a large, spontaneous TDC occupying most the retropharyngeal and mediastinal space. To our knowledge, this is the youngest patient to date presenting with TDC. Ultimately, his TDC was completely resolved with sclerotherapy, however the patient's age and size presented unique challenges to his medical management, which we describe below.
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Affiliation(s)
- Vidur Bhalla
- University of Kansas Medical Center, Department of Otolaryngology, Head and Neck Surgery, USA.
| | - Thomas Schrepfer
- Children's Mercy Hospital, Department of Pediatric Otolaryngology, USA
| | - Adam McCann
- University of Kansas, School of Medicine, USA
| | - Pamela Nicklaus
- Children's Mercy Hospital, Department of Pediatric Otolaryngology, USA
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Wan X, Zhou Z. A Giant Thoracic Duct Cyst as the Cause of Abdomen Pain: A Case Report and Review of the Literature. Ann Thorac Cardiovasc Surg 2015; 21:487-91. [PMID: 26004105 DOI: 10.5761/atcs.cr.14-00324] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Thoracic duct cysts, which may be of congenital or degenerative origin, are very rare lesions. Most patients are asymptomatic, but when symptoms are present they include cough, dyspnea, dysphagia and chest pain. However, in this case report a 35-year-old male patient presented to us with intermittent abdomen pain. Clinical symptoms and radiographic findings helped to identify a giant thoracic duct cyst in this patient. Surgical resection of the cyst resolved the abdominal symptoms. This was the first case reported in the literature of a thoracic duct cyst with the symptoms of abdominal pain.
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Affiliation(s)
- Xinyue Wan
- Department of Gastroenterology, Wuhan University, Renmin Hospital, China
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Dortch JD, Eck D, Hakaim AG, Casler JD. Management of cervical thoracic duct cyst with cyst-venous anastomosis. Int J Surg Case Rep 2014; 5:1028-30. [PMID: 25460465 PMCID: PMC4275970 DOI: 10.1016/j.ijscr.2014.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 08/12/2014] [Accepted: 10/08/2014] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION Cervical thoracic duct cyst (CTDC) is a rare cause of lateral neck mass. Surgical excision with ligation of the cervical thoracic duct is the current standard for definitive management with symptomatic patients. We report the first case of an alternative method of management performing a cyst venous anastomosis for decompression. PRESENTATION OF CASE A 77 year old female presented with a six month history of left arm pain, swelling and a left-sided cystic neck mass. She was treated with cyst-venous anastomosis between the cyst wall and the left internal jugular vein. At two year follow-up, she has had resolution of pain and no recurrence of the mass. DISCUSSION Many potential etiologies have been proposed for CTDC, though surgical management of this rare problem has consistently required cyst excision and thoracic duct ligation. Few innovative modes of therapy have been developed to address this problem in a less invasive manor. Maintaining a more natural thoracic duct anatomy decreases the likely of complications associated with duct ligation. CONCLUSION Cyst-venous anastomosis for the management of CTDC provides an effective, novel form of treatment which maintains the integrity of the thoracic duct and avoids potential complications associated with duct ligation.
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Affiliation(s)
- John D Dortch
- Department of Surgery, Mayo Clinic, Jacksonville, FL, United States.
| | - Dustin Eck
- Department of Surgery, Mayo Clinic, Jacksonville, FL, United States
| | - Albert G Hakaim
- Department of Surgery, Mayo Clinic, Jacksonville, FL, United States
| | - John D Casler
- Department of Otorhinolaryngology, Mayo Clinic, Jacksonville, FL, United States
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Gill MT, Lian TS, Thibodeaux JD, Nathan CAO. Cervical thoracic duct cyst: Importance of preoperative suspicion for appropriate management of left-sided neck mass. EAR, NOSE & THROAT JOURNAL 2013; 91:E13-5. [PMID: 23288824 DOI: 10.1177/014556131209101215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cervical thoracic duct cysts occur infrequently but are an important consideration when evaluating cystic supraclavicular masses. Only 22 cases have been reported to date. We review the clinical presentation, evaluation, and treatment of 2 cases of large thoracic duct cysts treated with surgical resection. A high suspicion of thoracic duct cyst based on location, radiographic findings, and fine-needle aspiration results is sufficient evidence for recommendation of surgical excision. However, enlarged cysts, as noted in our cases, can obliterate or attenuate the thoracic duct, making it difficult to identify intraoperatively. A high suspicion of thoracic duct cyst is important for identifying and ligating the duct to prevent complications such as chyle leak or chylothorax.
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Affiliation(s)
- Matthew T Gill
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Sciences Center, Shreveport, LA 71130, USA
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Kadkhodayan Y, Yano M, Cross DT. Direct puncture sclerotherapy of a thoracic duct cyst presenting as an enlarging left supraclavicular mass. J Neurointerv Surg 2013; 6:e44. [PMID: 24189372 DOI: 10.1136/neurintsurg-2013-010844.rep] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A 58-year-old woman presented with a palpable mass at the base of the left neck which she had first noticed 12 years previously, shortly after abdominal surgery. The mass had progressively enlarged, resulting in dysphagia, dyspnea and occasional pain. Imaging showed a septated but otherwise simple cystic mass extending into the mediastinum and containing lymphocytic fluid on aspiration. A diagnosis of the rare entity of a thoracic duct cyst with supraclavicular extension was made. The patient opted for percutaneous sclerotherapy of the lesion, which was performed using glacial acetic acid. This resulted in complete resolution of the mass with one treatment. After exclusion of other causes of cystic left supraclavicular masses including cystic neoplasms and pseudoaneurysms of the carotid or subclavian arteries, direct puncture sclerotherapy can be safe and effective.
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Affiliation(s)
- Yasha Kadkhodayan
- Department of Interventional Neuroradiology, Consulting Radiologists Ltd, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Motoyo Yano
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - DeWitte T Cross
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
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Rosique López L, Rosique Arias M. [Thoracic duct cyst, sclerosing treatment]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2013; 65:211-3. [PMID: 23507663 DOI: 10.1016/j.otorri.2013.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Revised: 12/20/2012] [Accepted: 01/03/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Lina Rosique López
- Servicio de otorrinolaringologia, Hospital Rafael Méndez Lorca, Murcia, España.
| | - Mariano Rosique Arias
- Servicio de otorrinolaringologia, Hospital virgen de la Arrixaca murcia, Murcia, España
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Turkyilmaz A, Eroglu A. A giant thoracic duct cyst: an unusual cause of dysphagia. J Thorac Cardiovasc Surg 2007; 134:1082-3. [PMID: 17903550 DOI: 10.1016/j.jtcvs.2007.05.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Accepted: 05/31/2007] [Indexed: 12/01/2022]
Affiliation(s)
- Atila Turkyilmaz
- Ataturk University, Medical Faculty, Department of Thoracic Surgery, Erzurum, Turkey.
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