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Oki S, Matsumoto K, Ueyama H, Iwano T, Utsunomiya H, Uchida R, Abe D, Suzuki N, Ikeda A, Yatagai N, Akazawa Y, Takeda T, Ueda K, Hojo M, Yao T, Nagahara A. Mediastinal Thoracic Duct Cyst Infection after Endoscopic Submucosal Dissection for Early Esophageal Cancer: A Case Report. Intern Med 2022. [PMID: 36351587 PMCID: PMC10372277 DOI: 10.2169/internalmedicine.0907-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
A mediastinal thoracic duct cyst that originates from the thoracic duct is a very rare disease in the mediastinum. There have been no reports of mediastinal thoracic duct cyst infection caused by endoscopic treatment. This is the first case of mediastinal thoracic duct cyst infection after endoscopic submucosal dissection for early esophageal cancer. We herein report a 75-year-old man with mediastinal thoracic duct cyst infection caused by esophageal endoscopic submucosal dissection. In cases where a mediastinal thoracic duct cyst is found before performing endoscopic esophageal treatment, we should carefully consider the potential risk of post-treatment cyst infection.
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Affiliation(s)
- Shotaro Oki
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Kohei Matsumoto
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Hiroya Ueyama
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Tomoyo Iwano
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Hisanori Utsunomiya
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Ryota Uchida
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Daiki Abe
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Nobuyuki Suzuki
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Atsushi Ikeda
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Noboru Yatagai
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Yoichi Akazawa
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Tsutomu Takeda
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Kumiko Ueda
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Mariko Hojo
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Takashi Yao
- Department of Human Pathology, Juntendo University Graduate School of Medicine, Japan
| | - Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
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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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Carreira-Delgado M, Fernández-Rodríguez E, Martínez-Míguez M, Álvarez-Martín MJ, Nuño Vázquez-Garza JM. [Cervical thoracic duct cyst: An uncommon entity]. CIR CIR 2017; 85 Suppl 1:40-43. [PMID: 28040230 DOI: 10.1016/j.circir.2016.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 11/17/2016] [Accepted: 11/26/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cervical thoracic duct cysts are a rare anomaly. OBJECTIVE To report a case of cervical thoracic duct cyst, and perform a literature review. CLINICAL CASE A 78-year-old female, with a one-year history of a left-sided asymptomatic supraclavicular cystic mass. Computerized tomography revealed a cystic mass 42mm in diameter. We performed a fine needle aspiration puncture, obtaining a thick, milky, whitish liquid. The patient underwent surgery; finding a left-sided supraclavicular cystic mass, with some lymph vessels heading towards the jugulo subclavian venous junction. We performed a ligation of these lymph vessels and resection of the mass. The histopathologic study confirmed the diagnosis of thoracic duct cyst. CONCLUSION Diagnosis of cervical thoracic duct cyst should be suspected with a cystic lesion in the left supraclavicular region, which when perforated exudes a very distinctive thick milky, whitish liquid with a high content of lymphocytes and triglycerides. Treatment should be complete removal with ligation of the lymphatic afferent vessels.
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Affiliation(s)
- Manuel Carreira-Delgado
- Servicio de Cirugía General, Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Vigo, España.
| | - Elvira Fernández-Rodríguez
- Servicio de Cirugía General, Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Vigo, España
| | | | - María Jesús Álvarez-Martín
- Servicio de Anatomía Patológica, Hospital Álvaro Cunqueiro, Complejo Hospitalario Universitario de Vigo, Vigo, España
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A thoracic duct cyst in 10-year-old boy: The youngest case report and review of the literature. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2016.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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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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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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Quiste espontáneo del conducto torácico cervical. RADIOLOGIA 2013; 55:455-6. [DOI: 10.1016/j.rx.2012.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 03/03/2012] [Accepted: 03/07/2012] [Indexed: 11/21/2022]
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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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Abstract
OBJECTIVE Lymphoceles are benign neck cysts that are important to differentiate from congenital, infectious, and malignant cystic neck masses because they require unique surgical treatment and follow-up. We reviewed a series of surgically proven lymphoceles to delineate the radiologic characteristics of lymphoceles that differentiate them from other cystic neck masses. MATERIALS AND METHODS A search of radiology report impressions for the terms "lymphocele" and "lymphatic cyst" was performed on all neck CT, MRI, and sclerotherapy studies from January 2003 to December 2009 at our institution. Clinical and pathology records were searched for the same terms to identify additional cases. Medical records confirmed diagnosis. Study images were reviewed on PACS to assess cyst location and imaging characteristics. RESULTS There were nine patients (six women and three men; age range, 22-85 years; mean age, 50.1 years) with 12 pathologically proven lymphoceles on six contrast-enhanced CT and three contrast-enhanced MRI examinations. Lymphoceles were located in the posterior cervical space in 12 of 12 and supraclavicular in 10 of 12 cases. Lymphoceles were unilocular nonseptated cysts in 12 of 12, fluid density or signal in 11 of 12, nonenhancing in 12 of 12, and lacked a cyst wall in eight of 12. CONCLUSION Lymphoceles are rare unilocular cystic neck masses that may mimic other congenital, infectious, and malignant neck cysts. When enhanced CT or MRI shows a unilocular, nonseptated, fluid density or intensity, and nonenhancing supraclavicular cyst in the posterior cervical space, lymphocele is an important part of the differential diagnosis. Atypical features warrant fine-needle aspiration or follow-up for confirmation.
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Lin HW, Lister MT, Deschler DG. Cystic masses of the supraclavicular fossa: clinical features and diagnostic strategies. Am J Otolaryngol 2010; 31:435-41. [PMID: 20015800 DOI: 10.1016/j.amjoto.2009.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 07/12/2009] [Accepted: 08/30/2009] [Indexed: 11/30/2022]
Abstract
PURPOSE Cystic masses of the supraclavicular fossa (SCF) are uncommon. The diverse anatomical structures within the SCF create an extended differential diagnosis for any mass arising in the SCF. This study describes the presenting symptoms, radiologic findings, medical and surgical management, and posttreatment outcomes of various cystic mass presenting in the SCF. A review of the literature and diagnostic and therapeutic algorithms are also provided. METHODS A retrospective study of an academic tertiary care head and neck cancer center was done. Seven cases of treated cystic masses of the SCF were identified. Diagnostic and therapeutic interventions are described. RESULTS Cross-sectional imaging and needle aspiration or biopsy were obtained in all 7 cases. Aspirates accurately differentiated benign from malignant lesions in 6 cases, identified the offending pathology in 3 cases, and provided inoculum for culture-directed antibiotic therapy in 1 case. Surgical intervention was used for definitive therapy in 6 cases. All patients achieved complete resolution of signs and symptoms of the mass. CONCLUSIONS Effective evaluation of a cystic lesion within the SCF mandates a thorough understanding of the anatomy and differential diagnosis. A well-defined algorithm allows successful management of benign and malignant lesions in the SCF.
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Affiliation(s)
- Harrison W Lin
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, USA.
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ZÄTTERSTRÖM U, AANESEN JP, KOLBENSTVEDT A. Spontaneous regression of a supraclavicular thoracic duct cyst: case report with a follow-up of 25 years. Br J Radiol 2009; 82:e148-50. [DOI: 10.1259/bjr/61472642] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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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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