1
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Gandhi D, Garg T, Shah J, Sawhney H, Crowder BJ, Nagar A. Gastrointestinal duplication cysts: what a radiologist needs to know. Abdom Radiol (NY) 2022; 47:13-27. [PMID: 34417830 DOI: 10.1007/s00261-021-03239-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 12/13/2022]
Abstract
Gastrointestinal tract duplication cysts are rare congenital malformations which can be diagnosed as early as the prenatal period but are frequently found in infancy or incidentally in adulthood. They can be seen throughout the alimentary tract with the most common involving the distal ileum and second most common the esophagus. Many duplication cysts are asymptomatic and thus discovered as an incidental imaging finding, though they can also be symptomatic with an array of clinical presentations dependent largely on their location. The vast majority of duplication cysts are benign; however, there are rare instances of malignant transformation reported. The aim of this review is to show how multimodality imaging can help in the diagnosis of duplication cysts at various anatomical locations. Duplication cyst can become symptomatic and in rare cases undergo malignant transformation; therefore, they are typically managed with surgical excision, particularly if found prenatally or during infancy. Given the diversity of anatomic locations, multiple differential diagnoses, and the need for surgical intervention, it is valuable to comprehend the role of multimodality imaging role in diagnosing duplication cysts.
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Affiliation(s)
- Darshan Gandhi
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair St, Suite 800, Chicago, IL, 60611, USA.
| | - Tushar Garg
- Department of Radiology, Seth GS Medical College & KEM Hospital, Acharya Donde Marg, Parel East, Parel, Mumbai, Maharashtra, 400012, India
| | - Jignesh Shah
- Department of Pediatric Radiology, University of Tennessee Health Science Center, Memphis, TN, 38103, USA
| | - Harpreet Sawhney
- Department of Radiology, Bridgeport Hospital at Yale New Haven Health, 167 Grant St, Bridgeport, CT, 06610, USA
| | - Benjamin James Crowder
- Department of Radiology, The Ohio State University Wexner Medical Center, 395W, 12th Av, 4th Floor, Columbus, OH, 43210, USA
| | - Arpit Nagar
- Department of Radiology, The Ohio State University Wexner Medical Center, 395W, 12th Av, 4th Floor, Columbus, OH, 43210, USA
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2
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Abstract
Pediatric cystic lung lesions have long been a source of confusion for clinicians, radiologists, and pathologists. They encompass a wide spectrum of entities with variable prognostic implications, including congenital lung malformations, pulmonary neoplasms, and hereditary conditions. As our understanding of the developmental and genetic origins of these conditions has evolved, revised nomenclature and classifications have emerged in an attempt to bring clarity to the origin of these lesions and guide clinical management. This review discusses cystic lung lesions and the current understanding of their etiopathogenesis.
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Affiliation(s)
- Nahir Cortes-Santiago
- Department of Pathology and Immunology, Baylor College of Medicine, BCM 315, One Baylor Plaza, Houston, TX 77030, USA; Department of Pathology, Texas Children's Hospital, 6621 Fannin Street Suite AB1195, Houston, TX 77030, USA
| | - Gail H Deutsch
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, USA; Department of Laboratories, Seattle Children's Hospital, OC.8.720, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA.
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3
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Microforceps in the Diagnosis of Pancreatic Bronchogenic Cyst Under Endoscopic Ultrasound Guidance. ACG Case Rep J 2020; 7:e00356. [PMID: 32337317 PMCID: PMC7162121 DOI: 10.14309/crj.0000000000000356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 02/03/2020] [Indexed: 11/17/2022] Open
Abstract
Bronchogenic cysts belong in the category of foregut duplication cysts, along with esophageal and neuroenteric duplication cysts. They are often found incidentally on cross-sectional imaging. Although they are benign, patients often undergo surgical resection because of diagnostic uncertainties. We report the first case of bronchogenic cyst diagnosed with the microforceps, after previous nondiagnostic fine-needle aspirations, thus allowing the patient to avoid surgery.
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4
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Leader BA, Rutter MJ, Shott SR, Smith MM. Endoscopic Removal of a Cervical Esophageal Duplication Cyst. Laryngoscope 2019; 130:2053-2055. [PMID: 31603535 DOI: 10.1002/lary.28326] [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: 05/19/2019] [Revised: 08/08/2019] [Accepted: 09/03/2019] [Indexed: 11/07/2022]
Abstract
A 6-month-old female presented for 2 months of noisy breathing. Flexible laryngoscopy showed limited bilateral vocal fold abduction. Computed tomography revealed a non-enhancing 3.6 × 2.3 × 3.5 cystic prevertebral mass spanning C2-T. Using an endoscopic approach, the overlying mucosa was incised, and the cyst was freed and fully excised from the surrounding mucosa with blunt microlaryngeal instruments without complication. Three months postoperatively she had no respiratory issues and was eating well. Flexible laryngoscopy revealed bilateral vocal fold mobility. We propose that endoscopic removal of a cervical esophageal duplication cyst in selected cases is an alternative to open excision. Laryngoscope, 130:2053-2055, 2020.
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Affiliation(s)
- Brittany A Leader
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A
| | - Michael J Rutter
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.,Division of Pediatric Otolaryngology-Head & Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Sally R Shott
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.,Division of Pediatric Otolaryngology-Head & Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
| | - Matthew M Smith
- Department of Otolaryngology-Head & Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, U.S.A.,Division of Pediatric Otolaryngology-Head & Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A
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5
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Rampersad R, Singh M, Parikh D. Foregut duplications in the superior mediastinum: beware of a common wall with the tracheo-bronchial tree. Pediatr Surg Int 2019; 35:673-677. [PMID: 30838439 DOI: 10.1007/s00383-019-04466-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Foregut duplication cysts (FD) with a common muscular wall with the oesophagus are well recognised. Our case series highlights the existence of a common wall between superior mediastinal FD and the tracheo-bronchial tree. MATERIALS AND METHODS Over the last 15 years, we have thoracoscopically resected 41 FD. Five cases were identified to have a common wall with the tracheo-bronchial tree at operation. The clinical history, radiology, findings at operation and pathology were evaluated to highlight learning points. RESULTS Five superior mediastinal cysts with a common wall were identified, with two antenatally and three postnatally diagnosed. All three postnatal cases and one antenatal case presented with symptoms of respiratory compromise and stridor. Only one neonate was relatively asymptomatic before resection. CT similarities in all cases were: separation of trachea and oesophagus by the cyst, oesophageal deviation to the right or compression and compression of trachea/bronchus. Thoracoscopically, two cysts were resected without injury to the airway, while three had inadvertent tracheo-bronchial injury. Repair of the tracheal injury was possible in one case thoracoscopically, while two cases required conversions, as adequate oxygenation could not be maintained despite on-table endotracheal tube advancement beyond the injury and thoracoscopic manoeuvres. All cases had excellent outcomes at follow-up (median 25months, range 4-39months) with resolution of symptoms and no recurrences. CONCLUSIONS Our report highlights the existence of a common wall between the superior mediastinal FD and the tracheo-bronchial tree. Thoracoscopic resections are feasible including repair of inadvertent airway injury, provided adequate oxygenation can be maintained.
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Affiliation(s)
- Rajay Rampersad
- Department of Paediatric Surgery, Centenary Hospital for Women and Children, Hospital Road, Garran, ACT, 2605, Australia.
| | - Michael Singh
- Department of Paediatric Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Dakshesh Parikh
- Department of Paediatric Surgery, Birmingham Children's Hospital, Birmingham, UK
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6
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Zhao Y, Wang R, Wang Y, Chen Q, Chen L, Hou W, Liu L, Gao W, Cheng B. Application of endoscopic ultrasound-guided-fine needle aspiration combined with cyst fluid analysis for the diagnosis of mediastinal cystic lesions. Thorac Cancer 2018; 10:156-162. [PMID: 30480367 PMCID: PMC6360264 DOI: 10.1111/1759-7714.12924] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/01/2018] [Accepted: 11/03/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Mediastinal cystic lesions account for approximately 15-20% of all mediastinal masses and are difficult to differentiate because of similar imaging manifestation. The aim of this study was to differentiate mediastinum cystic lesions through endoscopic ultrasound-guided-fine needle aspiration (EUS-FNA) and parameters from cyst-fluid analysis. METHODS Over a period of eight years, 37 patients suspected with mediastinal cystic lesions were assessed. Cyst fluid was collected via EUS-FNA and further examined using cytological and biochemical techniques. Definitive diagnosis was established based on cytology, surgical pathology, and/or clinical follow-up. RESULTS Based on the final pathological reports or long-term follow-up, 19 patients were diagnosed with benign cysts, 14 with benign or malignant tumors, 2 with tuberculosis, 1 with an abscess, and 1 with a pancreatic pseudocyst. Computed tomography or magnetic resonance imaging mistakenly distinguished eight cases as solid masses (27.03%), but EUS revealed cystic characteristics. Carcinoembryonic antigen and lactate dehydrogenase (LDH) were evaluated from the cyst fluid obtained by EUS-FNA. There was no statistically significant difference in carcinoembryonic antigen values between benign and malignant cysts; however the average LDH value in the malignancy group was significantly higher than in the benign group. CONCLUSION EUS-FNA showed great potential for differentiating mediastinal lesions by combining imaging manifestation and cytological examination. The elevated LDH value from cyst fluid chemical analysis could be used as an auxiliary indicator for diagnosing malignancy.
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Affiliation(s)
- Yuchong Zhao
- Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Ronghua Wang
- Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Yun Wang
- Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Qian Chen
- Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Liangkai Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, HUST, Wuhan, China
| | - Wei Hou
- Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
| | - Limin Liu
- Unit of Cytopathology Unit, Department of Surgery, Tongji Hospital, Tongji Medical College, HUST, Wuhan, China
| | - Wei Gao
- Department of Anesthesia, Xiangya Hospital, Central South University, Changsha, China
| | - Bin Cheng
- Department of Gastroenterology and Hepatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China
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7
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The Pediatric Esophagus. Dysphagia 2018. [DOI: 10.1007/174_2018_180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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8
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Han IS, Kim GH, Lee SJ, Lee BE, I H, Kim YD. [A Case of Hemorrhage of an Esophageal Duplication Cyst Improved by Endoscopic Drainage]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2017. [PMID: 28637106 DOI: 10.4166/kjg.2017.69.6.363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Esophageal duplication cyst is a rare congenital gastrointestinal malformation. It is the second most common duplication cyst following small bowel duplication cyst in the gastrointestinal tract. Patients with an esophageal duplication cyst are generally asymptomatic; however, some patients may present the following symptoms: dysphagia, chest pain, stridor, unproductive cough, and epigastric discomfort by compression of the surrounding structures. Surgical removal is the treatment of choice in symptomatic cases and can be considered in asymptomatic cases if they are at risk for developing complications, such as ulceration or perforation. Herein, we report a case of hemorrhage of an esophageal duplication cyst, which was improved by endoscopic drainage.
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Affiliation(s)
- In Sub Han
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Gwang Ha Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Seong Jun Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Bong Eun Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Hoseok I
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Yeong Dae Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University School of Medicine, Busan, Korea
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9
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Abstract
Esophageal duplication and congenital esophageal stenosis (CES) may represent diseases with common embryologic etiologies, namely, faulty tracheoesophageal separation and differentiation. Here, we will re-enforce definitions for these diseases as well as review their embryology, diagnosis, and treatment.
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Affiliation(s)
- A Francois Trappey
- David Grant Medical Center, Travis Air Force Base, California; Division of Trauma, Acute Care Surgery, and Surgical Critical Care, UC Davis Medical Center, Sacramento, California
| | - Shinjiro Hirose
- Department of Surgery, UC Davis Medical Center, Sacramento, California; Division of Pediatric General, Thoracic, and Fetal Surgery, UC Davis Medical Center, Sacramento, California; Shriners Hospitals for Children-Northern California, 2425 Stockton Blvd, Sacramento, California 95817.
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10
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Retrocardiac mediastinal foregut duplication cyst. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2016.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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11
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Benedict LA, Bairdain S, Paulus JK, Jackson CC, Chen C, Kelleher C. Esophageal duplication cysts and closure of the muscle layer. J Surg Res 2016; 206:231-234. [DOI: 10.1016/j.jss.2016.07.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 04/30/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
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12
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Kawashima S, Segawa O, Kimura S, Tsuchiya M, Henmi N, Hasegawa H, Fujibayashi M, Naritaka Y. A case of cervical esophageal duplication cyst in a newborn infant. Surg Case Rep 2016; 2:30. [PMID: 27037803 PMCID: PMC4818649 DOI: 10.1186/s40792-016-0157-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/28/2016] [Indexed: 12/11/2022] Open
Abstract
Esophageal duplication cyst is a rare congenital anomaly resulting from a foregut budding error during the fourth to sixth week of embryonic development. Cervical esophageal duplication cysts are very rare and may cause respiratory distress in infancy. A full-term newborn girl who was born by normal delivery was transferred to our hospital because of swelling of the right anterior neck since birth. Cervical ultrasonography showed a 40 × 24 × 33 mm simple cyst on the right neck. Tracheal intubation was required at 2 weeks of age because of worsening external compression of the trachea. Fine-needle aspiration cytology revealed the existence of ciliated epithelium. At 1 month of age, exploration was performed through a transverse neck incision. The cyst had a layer of muscle connected to the lateral wall of the esophagus. Histopathological diagnosis was a cervical esophageal duplication cyst. We describe the clinical features of infantile cervical esophageal duplication cysts based on our experience of this rare disease in a neonate, along with a review of 19 cases previously reported in literature.
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Affiliation(s)
- Shoko Kawashima
- Department of Surgery, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishi Ogu, Arakawa-ku, Tokyo, 116-8567, Japan.,Department of Pediatric Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Osamu Segawa
- Department of Surgery, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishi Ogu, Arakawa-ku, Tokyo, 116-8567, Japan. .,Department of Pediatric Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan.
| | - Shuri Kimura
- Department of Pediatric Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Masayoshi Tsuchiya
- Department of Surgery, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishi Ogu, Arakawa-ku, Tokyo, 116-8567, Japan.,Department of Pediatric Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, Japan
| | - Nobuhide Henmi
- Division of Neonatal Intensive Care, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishi Ogu, Arakawa-ku, Tokyo, 116-8567, Japan
| | - Hisaya Hasegawa
- Division of Neonatal Intensive Care, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishi Ogu, Arakawa-ku, Tokyo, 116-8567, Japan
| | - Mariko Fujibayashi
- Department of Diagnostic Pathology, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishi Ogu, Arakawa-ku, Tokyo, 116-8567, Japan
| | - Yoshihiko Naritaka
- Department of Surgery, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishi Ogu, Arakawa-ku, Tokyo, 116-8567, Japan
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13
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Bobanga ID, Redline RW, DeRoss AL. Oesophageal pseudodiverticulum after foregut duplication cyst excision: Case report and literature review. Afr J Paediatr Surg 2016; 13:50-3. [PMID: 27251526 PMCID: PMC4955461 DOI: 10.4103/0189-6725.181709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Oesophageal pseudodiverticula rarely occur after excision of benign oesophageal neoplasms. While management and outcomes have been reported in the adult leiomyoma literature, sparse data exist on the occurrence and management of pseudodiverticula after foregut duplication cyst excision. We discuss our experience with a paediatric patient and review relevant literature regarding operative techniques and surgical outcomes.
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Affiliation(s)
- Iuliana D Bobanga
- Department of General Surgery, University Hospital Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Raymond W Redline
- Department of Pathology, University Hospital Case Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Anthony L DeRoss
- Department of Pediatric Surgery, University Hospital Case Medical Center, Rainbow Babies and Children Hospital, Cleveland, Ohio, USA
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14
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Cuch B, Nachulewicz P, Wieczorek AP, Wozniak M, Pac-Kozuchowska E. Esophageal Duplication Cyst Treated Thoracoscopically During the Neonatal Period: Clinical Case Report. Medicine (Baltimore) 2015; 94:e2270. [PMID: 26656375 PMCID: PMC5008520 DOI: 10.1097/md.0000000000002270] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Esophageal duplication cysts (EDCs) are rare developmental anomalies. They may occur anywhere along the esophagus with the predominant location in the thoracic segment. Presently, most are diagnosed prenatally or in early childhood. The prevalence of EDCs is estimated at 1 in 8200 live births. Usually, cysts are asymptomatic in the neonatal period, but they may cause respiratory distress or feeding difficulties depending on the size and location of the lesion.This report presents a female neonate with a cyst located in the right pleural cavity recognized prenatally. Computed tomography confirmed the diagnosis and revealed a round cystic mass in proximity to the left lung base. Thoracoscopic cyst excision was undertaken on day 15 after delivery. The postoperative period was uneventful. Histological cyst examination confirmed the diagnosis of foregut duplication.This case underlines the importance of early diagnosis and treatment of EDC, before symptoms and complications arise, and confirms that surgery in the neonatal period is safe and effective.
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Affiliation(s)
- Barbara Cuch
- From the Department of Paediatric Surgery and Traumatology (BC, PN), Department of Paediatric Radiology (APW, MW), and Department of Paediatric, Medical University of Lublin, Lublin, Poland (EP-K)
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15
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Atoini F, Ouarssani A, Ouadnouni Y, Smahi M. Unusual mode of presentation of intrathoracic bronchogenic cyst: A double location. Respir Med Case Rep 2015; 17:12-6. [PMID: 27222776 PMCID: PMC4821250 DOI: 10.1016/j.rmcr.2015.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
A 63 year old woman presenting chronic back pain and neuralgia had abnormal shadow on chest radiograph. She has a history of pulmonary tuberculosis treated in 1977. The chest-CT scan showed a soft tissue mass in the lower lobe of the right lung and a cystic mass in the paravertebral region. The patient had right lower lobectomy and complete excision of a paraoesophageal cyst. Both masses were bronchogenic cysts at histology. The patient had an uneventful discharge the seventh postoperative day. After 4 years and 7 months of follow-up with CT-scann, the patient was free of symptoms with no evidence of recurrent disease.
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Affiliation(s)
- Fouad Atoini
- Thoracic Surgery Department, Moulay Ismail Military Hospital, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Aziz Ouarssani
- Pulmonology Department, Moulay Ismail Military Hospital, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Yassine Ouadnouni
- Thoracic Surgery Department, Hassan II university Hospital, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Mohammed Smahi
- Thoracic Surgery Department, Hassan II university Hospital, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
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16
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Multiple Bronchogenic and Gastroenteric Cysts Arising from the Stomach in a Patient with Abdominal Pain. Case Rep Surg 2015; 2015:601491. [PMID: 26246929 PMCID: PMC4506807 DOI: 10.1155/2015/601491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 06/23/2015] [Indexed: 01/01/2023] Open
Abstract
Bronchogenic cysts arising from the stomach are uncommon. We discuss a young female patient with presumed enteric duplication cysts who was found to have three bronchogenic and gastroenteric cysts upon pathologic review. We discuss the pathophysiology of bronchogenic cysts and their malignant potential.
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17
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Suda K, Sueyoshi R, Okawada M, Koga H, Lane GJ, Yamataka A, Doi T. Completely intramural bronchogenic cyst of the cervical esophagus in a neonate. Pediatr Surg Int 2015; 31:683-7. [PMID: 26002606 DOI: 10.1007/s00383-015-3720-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2015] [Indexed: 11/25/2022]
Abstract
Bronchogenic cysts are congenital cystic lesions of foregut origin, usually intrapulmonary or mediastinal, while esophageal cysts generally originate within the esophagus. To the best of our knowledge, this is the first report of a case of a completely intramural bronchogenic cyst of the cervical esophagus in a neonate.
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Affiliation(s)
- Kazuto Suda
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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18
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Niernberger T, Gabor SE, Rabl H. [Cystic space-occupying lesion of the mediastinum]. Chirurg 2015; 87:62-4. [PMID: 25971609 DOI: 10.1007/s00104-015-0016-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- T Niernberger
- Abteilung für Chirurgie-LKH Hochsteiermark/Leoben, Vordernbergerstrasse 42, 8700, Leoben, Österreich.
| | - S E Gabor
- Abteilung für Chirurgie-LKH Hochsteiermark/Leoben, Vordernbergerstrasse 42, 8700, Leoben, Österreich
| | - H Rabl
- Abteilung für Chirurgie-LKH Hochsteiermark/Leoben, Vordernbergerstrasse 42, 8700, Leoben, Österreich
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19
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Liu R, Adler DG. Duplication cysts: Diagnosis, management, and the role of endoscopic ultrasound. Endosc Ultrasound 2014; 3:152-60. [PMID: 25184121 PMCID: PMC4145475 DOI: 10.4103/2303-9027.138783] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 01/29/2014] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal tract duplication cysts are rare congenital gastrointestinal malformation in young patients and adults. They consist of foregut duplication cysts, small bowel duplication cysts, and large bowel duplication cysts. Endoscopic ultrasound (EUS) has been widely used as a modality for the evaluation and diagnosis of duplication cysts. EUS is the diagnostic tool of choice to investigate duplication cysts since it can distinguish between solid and cystic lesions. The question of whether or not to perform EUS-fine needle aspiration (EUS-FNA) on a lesion suspected of being a duplication cyst is controversial as these lesions can become infected with significant consequences, although EUS-FNA is often required to obtain a definitive diagnosis and to rule out more ominous lesions. This manuscript will review the literature on duplication cysts throughout the body and will also focus on the role of EUS and FNA with regards to these lesions.
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Affiliation(s)
- Roy Liu
- Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Huntsman Cancer Center, Salt Lake City, Utah, USA
| | - Douglas G Adler
- Department of Gastroenterology and Hepatology, University of Utah School of Medicine, Huntsman Cancer Center, Salt Lake City, Utah, USA
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20
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Abstract
Esophageal duplication cyst is a rare congenital mediastinal cyst. Most of these cysts become symptomatic in childhood and only rare cases remain asymptomatic until adolescence. They may produce symptoms due to esophageal and respiratory system compression, rupture, and infection. A 25-year-old man presented with pulmonary infection and bronchiectasis that did not improve with medical treatment. A diagnosis of esophageal duplication cyst was made intraoperatively.
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Affiliation(s)
- Reza Bagheri
- Cardiothoracic Surgery & Transplant Research Center, Emam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Reza Afghani
- Cardiothoracic Surgery & Transplant Research Center, Emam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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21
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A lesser sac bronchogenic cyst treated with laparoscopic reduced port surgery. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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22
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Tooh MM, El Ezzi O, Dolci M, Boegli Y, Ikonomidis C, de Buys Roessingh A. Duplication of the cervical esophagus: An unusual cause of respiratory arrest in a child. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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23
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Knod JL, Garrison AP, Frischer JS, Dickie B. Foregut duplication cyst associated with esophageal atresia and tracheoesophageal fistula: a case report and literature review. J Pediatr Surg 2013; 48:E5-7. [PMID: 23701808 DOI: 10.1016/j.jpedsurg.2013.02.071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 02/12/2013] [Accepted: 02/25/2013] [Indexed: 10/26/2022]
Abstract
A case of esophageal atresia associated with a foregut duplication cyst is reported and the literature reviewed. This is the first documented occurrence in conjunction with Down syndrome and the second case where both anomalies were treated at the initial surgery.
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Affiliation(s)
- J Leslie Knod
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC-2023, Cincinnati, Ohio 45229, USA.
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24
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Al-Balushi Z, Ehsan MT, Al Sajee D, Al Riyami M. Scapular bronchogenic cyst: a case report and literature review. Oman Med J 2012; 27:161-3. [PMID: 22496944 DOI: 10.5001/omj.2012.33] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Accepted: 12/24/2011] [Indexed: 11/03/2022] Open
Abstract
Bronchogenic cysts originate from abnormal budding of the tracheal diverticula during the embryological period. Inaccuracy in the process of growing of the ventral foregut will give rise to bronchogenic cyst. Scapular bronchogenic cyst is an extremely rare form of this anomaly. A three years old boy suffered for 2 years with left sided suprascapular cystic lesion which was gradually increasing in size. The swelling was 4 × 3 cm in size and non tender. The cyst was evaluated by CT scan that showed complex cystic lesion over the left scapular spine. Total excision of the cyst was done and histopathology showed cutaneous bronchogenic cyst. The proposed mechanism for such cutaneous lesion is that the accessory buds from the tracheobronchial tree/primitive foregut migrated from the thorax in an aberrant manner to lie in periscapular positions. The definitive treatment of scapular lesions is total surgical excision. The final diagnosis is based on the histopathological findings in the majority of cases.
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Affiliation(s)
- Zainab Al-Balushi
- Consultant Pediatric Surgeon, Sultan Qaboos University, Muscat, Sultanate of Oman
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25
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Abstract
This is a rare case of a bronchogenic cyst found below the diaphragm within the lesser sac successfully resected by laparoscopic means. Bronchogenic cysts rarely develop in the abdomen they typically reside in the mediastinum. We present a unique case of a bronchogenic cyst within the lesser sac. Endoscopic ultrasound proved to be a critical diagnostic tool, and the patient underwent a laparoscopic resection of the lesion.
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26
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27
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Davenport M, Eber E. Long term respiratory outcomes of congenital thoracic malformations. Semin Fetal Neonatal Med 2012; 17:99-104. [PMID: 22305631 DOI: 10.1016/j.siny.2012.01.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The advent of universal antenatal ultrasonography in many countries has revealed the full spectrum of congenital thoracic malformations (CTMs) and presented clinicians with a number of practical dilemmas to do with diagnosis and management. We present a review of the most common forms of CTMs, including congenital cystic adenomatoid malformation, bronchopulmonary sequestration, and lobar and segmental emphysema.
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Affiliation(s)
- Mark Davenport
- Department of Paediatric Surgery, King's College Hospital, London, UK.
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28
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Kelleher CM, Forcione DG, Gee MS, Mino-Kenudson M. Case records of the Massachusetts General Hospital. Case 10-2012. A 16-year-old boy with epigastric pain and a mediastinal mass. N Engl J Med 2012; 366:1241-9. [PMID: 22455419 DOI: 10.1056/nejmcpc1110055] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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29
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Pachl M, Patel K, Bowen C, Parikh D. Retroperitoneal gastric duplication cyst: a case report and literature review. Pediatr Surg Int 2012; 28:103-5. [PMID: 22138979 DOI: 10.1007/s00383-011-3036-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2011] [Indexed: 02/05/2023]
Abstract
A rare case of retroperitoneal gastric duplication is reported and discussed. An intra-abdominal cyst was detected at 31 weeks gestation and was followed up prenatally as a left sided duplex kidney. Post-natal ultrasound however, showed a normal kidney, but a cyst with features of enteric duplication in the left upper quadrant adjacent and compressing the kidney. Surgery was carried out during infancy and a retroperitoneal cyst was excised that contained heterotrophic gastric mucosa.
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Affiliation(s)
- Max Pachl
- Department of Paediatric Surgery, Birmingham Children's Hospital NHS Trust, Steelhouse Lane, Birmingham, B4 6NH, UK
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30
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Benson JE. The Pediatric Esophagus. Dysphagia 2012. [DOI: 10.1007/174_2012_582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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31
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Serour F, Vaknine H, Karplus G. A foregut cyst presenting as an umbilical mass in a newborn. Pediatr Surg Int 2010; 26:855-8. [PMID: 20563873 DOI: 10.1007/s00383-010-2595-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2010] [Indexed: 12/01/2022]
Abstract
We described for the first time a foregut cyst presenting as an umbilical mass in a female infant. The diagnosis was made microscopically. This case illustrates, based on varied histologic findings, the complexity in classifying such cysts, in view of existing terminology.
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Affiliation(s)
- Francis Serour
- Department of Pediatric Surgery, The E. Wolfson Medical Center, Holon, Israel.
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32
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Abstract
Congenital malformations of the esophagus are frequently encountered by pediatric surgeons, especially esophageal atresia with or without tracheo-esophageal fistula. However, the molecular mechanisms underlying the development of these various anomalies are not clear. Here we present a brief overview of the embryologic development of the tracheoesophageal tube, along with some of the genetic controls which, when defective can lead to abnormal separation of this tube.
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Affiliation(s)
- Yousef El-Gohary
- Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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33
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Diehl DL, Cheruvattath R, Facktor MA, Go BD. Infection after endoscopic ultrasound-guided aspiration of mediastinal cysts. Interact Cardiovasc Thorac Surg 2009; 10:338-40. [PMID: 19917550 DOI: 10.1510/icvts.2009.217067] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Foregut duplication cysts are rare congenital anomalies of enteric origin that arise during early embryonic development. They are usually incidentally found on routine imaging studies. The diagnosis can usually be made by computed tomography (CT) and endoscopic ultrasound (EUS) appearance. On CT, cyst attenuation values usually measure 0+/-20 Hounsfield units (HU). Higher HU is possible with hemorrhage, proteinaceous material or septations. At EUS, characteristic location and anechoic as well as hypoechoic but not necessarily anechoic appearance may be suggestive of a foregut duplication cyst. EUS-guided fine needle aspiration (FNA) has been thought to provide a safe, minimally invasive approach to establish the diagnosis. The purpose of this report is to highlight the potential for infectious risk of EUS-FNA for these cysts, and to suggest CT and EUS features that can suggest this diagnosis without FNA. Three patients who underwent EUS-FNA for diagnosis of incidental mediastinal lesions developed cyst infection despite accepted techniques including prophylactic antibiotics. Combined CT and EUS appearance may be sufficient in making this diagnosis without FNA. IV antibiotics may not be completely protective against infectious complications of FNA of mediastinal duplication cysts.
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Affiliation(s)
- David L Diehl
- Department of Gastroenterology, Geisinger Medical Center, Danville, PA 17821, USA.
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34
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Sahinoglu Z, Peker H, Etker S, Celayir A, Cesur S. Difficulties in perinatal diagnosis of fetal thoracic foregut cysts: Report of two cases. J OBSTET GYNAECOL 2009; 25:211-4. [PMID: 15814417 DOI: 10.1080/014436110500051213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Z Sahinoglu
- Division of Perinatology, Department of Obstetrics and Gynaecology, Zeynep Kamil Women and Children Diseases Education and Research Hospital, Uskudar, Istanbul Turkey.
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35
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Costa Júnior ADS, Perfeito JAJ, Forte V. Surgical treatment of 60 patients with pulmonary malformations: what have we learned? J Bras Pneumol 2009; 34:661-6. [PMID: 18982202 DOI: 10.1590/s1806-37132008000900005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Accepted: 01/24/2008] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To retrospectively analyze the medical charts of patients with pulmonary malformations submitted to surgical treatment and to investigate the clinical evolution prior to the definitive diagnosis. METHODS We analyzed the medical charts of patients with pulmonary malformations operated on at the São Paulo Hospital-Federal University of São Paulo/Paulista School of Medicine-from 1969 to 2004. Each medical chart was analyzed as to the following aspects: clinical profile; diagnosis; previous treatment; surgical treatment; and nosocomial complications. The inclusion criteria were having received a diagnosis of pulmonary malformation, having undergone pulmonary resection, and chart data being complete. RESULTS The analysis of the medical charts revealed that 60 patients diagnosed with pulmonary malformations-27 cases of bronchogenic cyst, 14 cases of congenital lobar emphysema, 10 cases of pulmonary sequestration, and 9 cases of cystic adenomatoid malformation-underwent surgery. Ages ranged from 4 days to 62 years (mean, 17.9 years). There was a predominance of males (55%). Ninety-two percent of the patients presented symptoms (mean duration: 15.37 months). Of the 60 patients undergoing surgery, 27 (45%) received preoperative home or hospital treatment with antibiotics. Regarding complications, we observed that morbidity was 23%, and mortality was 3.3%. Surgical times ranged from 1 to 8 h (mean, 3.2 h). CONCLUSIONS Misdiagnosis or delayed diagnosis of pulmonary malformations resulted in unnecessary treatments and hospitalizations, as well as in frequent, recurrent infectious complications. We believe that the definitive treatment is surgery, which is curative and has low morbidity and mortality rates.
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Affiliation(s)
- Altair da Silva Costa Júnior
- Department of Surgery, Thoracic Surgery Section, Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, Brazil.
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36
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Abstract
We report a rare case of a 3-year-old male child with scapular bronchogenic cyst. The cyst was excised because of associated pain and discharge from the swelling. Till date, 64 cases of cutaneous bronchogenic cyst have been reported in the literature. Only 12 of these patients had lesion located in periscapular area. The treatment is surgical as it can undergo malignant transformation.
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Affiliation(s)
- Anjani Kumar Kundal
- Department of Pediatric Surgery, Sir Ganga Ram Hospital, Delhi - 110 060, India
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37
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Pasquali R, Potier A, Gorincour G. [Fetal lung imaging]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2008; 36:587-602. [PMID: 18486517 DOI: 10.1016/j.gyobfe.2008.03.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2008] [Accepted: 03/31/2008] [Indexed: 05/26/2023]
Abstract
Exponential improvements in imaging techniques over the last ten years, through patients' and physicians' wishes for less invasive fetal work-up, now allow us to better explore and understand fetal lung physiology during pregnancy. Diagnostic and prognostic consequences at stake are huge, especially for fetuses at risk of pulmonary hypoplasia. We will decline in three parts (normal lung, malformative lung and pulmonary hypoplasia), through a review of the literature and at the light of our experience, the potentialities and limitations of all imaging modalities (Ultrasound, Doppler, 3D, MRI). Then, we will dwell on future leads and the need for large-scale collaborative studies.
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Affiliation(s)
- R Pasquali
- Service de radiologie pédiatrique, hôpital de la Timone-Enfants, 264, rue Saint-Pierre, 13385 Marseille cedex 5, France
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38
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Kang CU, Cho DG, Cho KD, Jo MS. Thoracoscopic stapled resection of multiple esophageal duplication cysts with different pathological findings. Eur J Cardiothorac Surg 2008; 34:216-8. [PMID: 18486485 DOI: 10.1016/j.ejcts.2008.04.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Revised: 04/06/2008] [Accepted: 04/14/2008] [Indexed: 11/17/2022] Open
Abstract
Esophageal duplication cyst is a rare congenital esophageal anomaly of the foregut. This cyst usually occurs in isolation, and thus far, was treated by enucleation through thoracoscopic or thoracotomic surgery. Here we report a case of multiple esophageal duplication cysts that showed different pathological findings, i.e., the cysts were lined with pseudostratified ciliated columnar and stratified squamous epithelium. Esophageal cysts were incidentally detected in a 53-year-old man during the treatment of pneumonia. In chest-computed tomography, the cysts showed a thin wall and homogeneous inner density, while in endoscopy, no communication with esophageal mucosa was observed. We resected the esophageal cysts with endo-staplers under thoracoscopic surgery. No postoperative complications, including esophageal mucosal injury, occurred. A follow-up chest computed tomography revealed the complete resection of the cysts.
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Affiliation(s)
- Chul Ung Kang
- Department of Thoracic and Cardiovascular Surgery, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Paldal-Gu, Suwon, Gyeonggi-Do, South Korea. >
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39
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Keller A(H. What To Do? She's Turning Blue! CLINICAL PEDIATRIC EMERGENCY MEDICINE 2008. [DOI: 10.1016/j.cpem.2007.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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Mediastinum. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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41
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Abstract
Because of the common embryologic origin, alteration of the many factors modulating the development of the alimentary and the respiratory tract often results in structural abnormalities involving the two systems. Indeed, some of the most common embryologic disorders of the airways are frequently associated with anomalies of the gastrointestinal tract. Lung growth occurs as a series of tightly regulated events, depending on a number of factors, including developmental, genetic and environment ones. Abnormalities of any of these factors may causes developmental alterations of the lung leading to a group of disorders termed "bronchopulmonary-foregut malformations". These are usually sporadic, solitary cystic hamartomas, involving conducting airways, arteries, venous drainage, and lung parenchyma, which are now often discovered on routine prenatal sonography. While some lesions may be large and cause serious complications in the foetus or newborn, many will be asymptomatic at birth, raising controversy about management: simple observation or surgery and, if so, at what age? Over the past two decades molecular studies have started to shed light on the complex series of events that control proper formation of the lung, with the hope that a better understanding of the molecular basis of pulmonary maturation will allow the design of new therapeutic strategies.
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Affiliation(s)
- Donata Girosi
- Pulmonary and Allergy Units, G. Gaslini University Hospital, Genoa, Italy
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42
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Schouten van der Velden AP, Severijnen RSVM, Wobbes T. A bronchogenic cyst under the scapula with a fistula on the back. Pediatr Surg Int 2006; 22:857-60. [PMID: 16924507 DOI: 10.1007/s00383-006-1753-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2006] [Indexed: 10/24/2022]
Abstract
A 20-year-old patient with a chronic fistula located at the left scapular region caused by a deep located subscapular bronchogenic cyst is described.
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43
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Perger L, Azzie G, Watch L, Weinsheimer R. Two Cases of Thoracoscopic Resection of Esophageal Duplication in Children. J Laparoendosc Adv Surg Tech A 2006; 16:418-21. [PMID: 16968197 DOI: 10.1089/lap.2006.16.418] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
We report two cases of thoracoscopic resection of esophageal duplication cysts. Both patients underwent successful thoracoscopic excision. They were discharged on postoperative day 2 and 4, respectively. They made uneventful recoveries and were completely asymptomatic at 1-month followup. One child was lost to long-term follow-up. In the other child, barium swallow study 10 months after surgery demonstrated a pseudodiverticulum at the site of cyst excision. Thoracoscopic resection of esophageal duplications is safe. Complete excision is possible even if the cyst shares a common muscular wall with the esophagus. Pseudodiverticulum may develop at the site of excision: follow- up is necessary and consideration should be given to closure of the muscular defect at the time of excision. To help avoid esophageal injury and, should it occur, recognize esophageal perforation, we recommend performing the dissection under intraesophageal endoscopic supervision.
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Affiliation(s)
- Lena Perger
- Department of Pediatric Surgery, University of New Mexico Children's Hospital, Albuquerque, New Mexico 87131, USA
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44
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Abstract
Antenatally diagnosed lung lesions are most commonly congenital cystic adenomatiod malformations (CCAMs) or bronchopulmonary sequestrations (BPS). Congenital lobar emphysema and bronchogenic cysts occur rarely. CCAMs and BPS can only be truly distinguished on histopathological assessment. CCAMs can be defined using either Stocker's histological classification, or the clinically more useful 'macrocystic' and 'microcystic' subtypes introduced by Adzick. Adverse pathophysiological effects (e.g. lung hypoplasia, mediastinal shift, caval obstruction and hydrops) can occur with those of larger volume in the developing fetus and are associated with a poor outcome ( approximately 5%). In centres with appropriate expertise, antenatal intervention (e.g. thoracoamniotic shunting) should be considered for such cases. In the postnatal period, early radiological evaluation (e.g. CT scan) is essential as many cases which apparently 'regress' antenatally are still detectable and may be a cause of later morbidity. Early surgical excision is required for symptomatic cases and should also be considered for asymptomatic antenatally diagnosed lesions, because of the risks of later infection and the possibility of malignant transformation. An excellent outcome following surgery can be expected.
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Affiliation(s)
- Michael Stanton
- Department of Paediatric Surgery, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom
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45
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Collison SP, Tomar M, Shrivastava S, Iyer KS. A rare intrapericardial enterogenous cyst presenting in infancy. Ann Thorac Surg 2006; 81:e11-2. [PMID: 16564236 DOI: 10.1016/j.athoracsur.2005.12.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2005] [Revised: 12/01/2005] [Accepted: 12/02/2005] [Indexed: 10/24/2022]
Abstract
We report an infant with an intrapericardial enterogenous cyst, and discuss the differential diagnosis of intrapericardial cysts presenting in infancy.
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46
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Abstract
Can all congenital cystic lung lesions be treated conservatively, without the need for surgery? Our purpose here is to present the morbidity associated with symptomatic cystic lung lesions which have failed to respond to medical treatment. In the past 8 years, 22 consecutive cystic thoracic lesions were retrospectively assessed for clinical presentation, diagnostic modalities, operative findings, technical tribulations, and outcome. The endpoint was complete cessation of recurrent pneumonia and dysphagia. Age at presentation was 7.7 +/- 2.2 years, with 4 +/- 2 episodes per year of lower respiratory tract infection, which had been treated for the past 2.6 +/- 0.3 years. Cough and dyspnea (100%) were the common symptoms, with episodes of cyanosis occurring in 58%. Other significant clinical presentations were dysphagia (55%), failure to thrive (55%), chest pain (46%), haemoptysis (18%), and pleuritic pain (18%). Definitive growth was seen in 91% of the excised specimens. Preoperative morbidity resulted from intractable pneumonia, dysphagia, and failure to thrive. Surgical excision was curative. All 22 children after resection are thriving, with an absence of pneumonia and dysphagia, with normal ventilation/perfusion scans, at 48 +/- 6 months of follow-up. In conclusion, surgical excision of a symptomatic cystic lung lesion that has not responded to medical treatment is recommended.
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Affiliation(s)
- Dakshesh Parikh
- Department of Paediatric Surgery, Birmingham Children's Hospital, Birmingham, UK
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47
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de Buys Roessingh AS, Rosato L, Meagher-Villemure K, Hohlfeld J. Clinical quiz: right lateral cervical mass followed by difficulty eating two weeks later. What is your diagnosis? J Pediatr Gastroenterol Nutr 2005; 41:259-62. [PMID: 16056111 DOI: 10.1097/01.mpg.0000153885.73687.3c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Anthony S de Buys Roessingh
- Department of Pediatric Surgery, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland.
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48
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Vlodavsky E, Czernobilsky B, Bar Y, Lifschitz-Mercer B. Gastric mucosa in a bronchogenic cutaneous cyst in a child: case report and review of literature. Am J Dermatopathol 2005; 27:145-7. [PMID: 15798441 DOI: 10.1097/00000372-200504000-00012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report a case of cutaneous bronchogenic cyst, partially lined by gastric mucosa of antral type in a 9-year-old boy. This is, to the best of our knowledge, the first report of gastric mucosa in bronchogenic cutaneous cyst in the literature.
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49
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Abstract
Congenital lung abnormalities include a wide spectrum of conditions and are an important cause of morbidity and mortality in infants and children. This article discusses focal lung abnormalities and the dysmorphic lung. Pulmonary arteriovenous malformations have been included at the end of the article. Anomalies affecting the pulmonary parenchyma, its arterial supply, and venous drainage are thus discussed.
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Affiliation(s)
- Anne Paterson
- Radiology Department, Royal Belfast Hospital for Sick Children, 180 Falls Road, Belfast BT12 6BE, UK.
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50
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Abstract
PURPOSE Thoracoscopy has an expanding role in the treatment of FD cysts (bronchogenic cysts and esophageal duplications). We examined this trend in our patients and reviewed our overall experience. METHODS All charts of children undergoing surgery for foregut duplications (FDs) in 2 pediatric hospitals between 1992 and 2003 were retrospectively reviewed. Data gathered included age, weight, symptoms, diagnostic tests, operative technique, postoperative course, complications, and outcome. RESULTS There were 39 children, with FD resected by thoracotomy in 21 patients, thoracoscopy in 11 patients (no conversions to open), cervical incision in 6 patients, and laparotomy in 1 patient for an FD near the gastroesophageal junction. Diagnosis was made by antenatal ultrasound in 7 cases. Four of these neonates had tachypnea or cough, and the rest were asymptomatic. Seventy-five percent of patients diagnosed postnatally presented with respiratory symptoms. Excision of isolated FD (without lung resection) was compared between those who had a thoracotomy (n = 16) vs thoracoscopy (n = 11). The age, weight, operating time, and anesthesia time were not different between the 2 groups. However, the thoracoscopy group had significantly fewer chest tube days (1.6 vs 3.3 days) and a shorter hospital stay (2.6 vs 6.6 days). Intraoperative complications consisted of tracheal injury in 3 patients (2 thoracotomy, 1 thoracoscopy) and esophageal mucosal injury in 2 patients (both thoracotomy), which were all recognized and repaired. CONCLUSION Foregut duplications may present in a variety of ways and locations. Thoracoscopy is advantageous for isolated intrathoracic FDs.
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Affiliation(s)
- Ioana Bratu
- Division of Pediatric Surgery, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, H3H-1P3, Canada
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