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Khan Z, Batchelor T, Rees P. Bronchogenic cyst: a rare cause of palpitations and atrial fibrillation. BMJ Case Rep 2024; 17:e259480. [PMID: 38442975 PMCID: PMC11107077 DOI: 10.1136/bcr-2023-259480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 03/07/2024] Open
Abstract
Bronchogenic cysts are rare congenital lesions found primarily in the mediastinum. Most patients are asymptomatic and can be treated with minimally invasive resection. We present a case of a middle-aged patient who presented to a district general hospital with palpitations and shortness of breath. She underwent a computerised tomographic pulmonary angiogram that showed a likely bronchogenic cyst and was subsequently transferred to our hospital. She developed atrial fibrillation during admission requiring therapy with beta-blockers and digoxin. Cardiac MRI revealed a large cyst posterior to the left atrium, a moderate circumferential pericardial effusion and bilateral pleural effusions. There was significant left atrial compression. The patient underwent surgical removal of the cyst and was discharged. She returned to the hospital within a week with palpitations and was treated with intravenous antibiotics for sepsis. She was discharged a week later and remained clinically stable.
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Affiliation(s)
- Zahid Khan
- Cardiology, Barts Health NHS Trust, London, UK
- Cardiology & Medical Education, University of South Wales, Pontypridd, UK
| | - Tim Batchelor
- Cardiothoracic Surgery, Barts Health NHS Trust, London, UK
| | - Paul Rees
- Queen Mary University of London, Queen Mary University of London Blizard Institute, London, UK
- Academic Department of Military Medicine, London, UK
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Liao Z, Wang H, An J, Dong J, Long X. A 49-Year-Old Man With Fever and Dyspnea After Endobronchial Ultrasound-Guided Transbronchial Fine Needle Aspiration Biopsy. Chest 2024; 165:e65-e69. [PMID: 38461020 DOI: 10.1016/j.chest.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/03/2023] [Accepted: 08/11/2023] [Indexed: 03/11/2024] Open
Abstract
CASE PRESENTATION A 49-year-old man, a farmer, had been experiencing coughing, phlegm, and difficulty breathing for 2 months. He underwent a CT scan at a local hospital that showed a mediastinal mass. Bronchoscopy showed no obstruction in the tracheal lumen, and an endobronchial ultrasound-guided transbronchial fine needle aspiration (EBUS-TBNA) biopsy was performed on the mediastinal mass. The cytologic smear of the mediastinal mass showed a few atypical epithelial cells; the possibility of a tumor could not be ruled out. The patient visited our thoracic surgery outpatient department; based on the advice of the thoracic surgeon, the patient underwent another endobronchial ultrasound-guided transbronchial fine needle aspiration biopsy of the mediastinal mass 4 days before this admission. The patient went home and waited for the results. Two days later, the patient experienced a fever and palpitations accompanied by chills, yellow phlegm, and orthopnea. The patient visited our ED, underwent tracheal intubation, and was admitted to our ICU. The patient had had occasional coughing and phlegm for the past 10 years, which were not taken seriously or investigated. The patient does not smoke or drink alcohol, and there is no history of cancer in the family.
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Affiliation(s)
- Zenglin Liao
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China.
| | - Hao Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Jing An
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Jiajia Dong
- Department of Respiratory and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaoyu Long
- Department of Pathology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
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Weissferdt A. Non-Neoplastic Thoracic Cysts: A Clinicopathologic Study of 136 Cases. Am J Surg Pathol 2023; 47:1349-1363. [PMID: 37642507 DOI: 10.1097/pas.0000000000002115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Benign cysts of the thoracic cavity represent a group of rare lesions, the spectrum of which is expanding. Most of these are congenital in nature, secondary to abnormal development during embryogenesis while a smaller subset represents acquired lesions. We retrospectively reviewed the clinicopathologic features of 136 patients with thoracic cysts that were treated in our institution over a span of 20 years. The patients were 85 female and 51 male patients with an average age of 51 years. Eighty-four of the patients were asymptomatic (62%), the remainder mainly presented with chest pain, shortness of breath, or cough. Surgical resection was performed in 123 patients while 12 patients were treated with aspiration only and 1 underwent core biopsy. The cyst size ranged from 0.5 to 14.8 cm (mean, 4.4 cm); histologically, the lesions included 50 thymic cysts (28 multilocular; 22 unilocular), 37 bronchogenic cysts, 23 pleuropericardial cysts, 12 unclassified cysts, 6 Müllerian cysts, 5 enteric cysts, and 3 parathyroid cysts. Clinical follow-up revealed that 97 patients were alive and well 4 months to 37 years after initial diagnosis; 25 patients were lost to follow-up and 14 patients died of unrelated causes. The current study is one of the largest studies on the subject with emphasis on clinicopathologic characteristics. This series has a higher incidence of thymic cysts compared with prior publications and covers a wider spectrum of different histologic types than previously reported.
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Affiliation(s)
- Annikka Weissferdt
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Mora A, Ghavamrezaii A, Abidali H, Caballero H, Hamidullah A, Mitzov N. Mediastinal Bronchogenic Cyst With Superior Vena Cava Syndrome: A Case Report. Cureus 2023; 15:e42040. [PMID: 37593276 PMCID: PMC10431947 DOI: 10.7759/cureus.42040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
Bronchogenic cysts are rare in adults and often remain undetected until discovered incidentally on imaging or during a symptomatic investigation. The possibility of superior vena cava (SVC) compression due to a bronchogenic cyst arises in complex patient presentations. SVC syndrome poses several unique challenges due to the wide range of clinical symptoms and difficulty identifying the cause when symptoms first manifest. This case report examines a 39-year-old male who presented with symptoms resulting from SVC compression caused by a bronchogenic cyst, leading to SVC syndrome. We discuss the various imaging modalities used to assess the severity of the obstruction and the surgical interventions employed to alleviate the symptoms. A surgical intervention provides symptomatic relief and promises an excellent prognosis when performed without complications.
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Affiliation(s)
- Annalee Mora
- Internal Medicine, Oak Hill Hospital, Brooksville, USA
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Hong Z, Sheng Y, Cui B, Bai X, Cheng T, Lu Y, Wu X, Jin D, Gou Y, Zhao J. A comparative study of robotic surgery and thoracoscopic surgery for mediastinal cysts. BMC Surg 2023; 23:102. [PMID: 37118795 PMCID: PMC10148468 DOI: 10.1186/s12893-023-01994-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/07/2023] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVE To compare the efficacy and safety of robotic-assisted thoracoscopic surgery (RATS) with video-assisted thoracoscopic surgery (VATS) in the treatment of mediastinal cysts. METHODS Retrospective analysis on clinical data of 70 cases of minimally invasive surgery for mediastinal cysts completed in the Department of Thoracic Surgery, Gansu Provincial People's Hospital from April 2014 to December 2022. There were 34 cases in the RATS group with a cyst diameter of (3.70 ± 1.16) cm and 36 cases in the VATS group with a cyst diameter of (4.07 ± 1.20) cm. All cysts were evaluated preoperatively using magnetic resonance imaging (MRI) or chest computed tomography (CT) localization. Surgery-related indices were compared among the two groups. RESULTS All patients in two groups successfully completed resection of mediastinal cysts without perioperative deaths. Compared with the VATS group, the RATS group possessed shorter operative time [(75.32 ± 17.80) min vs. (102.22 ± 19.80) min, P < 0.001], lesser intraoperative bleeding [10 (5.00, 26.00) ml vs. 17.50 (5.00, 50.50) ml, P = 0.009], shorter postoperative chest drainage time [2 (1.00, 6.00) ml vs. 3 (2.00, 6.50) ml, P = 0.006] and shorter postoperative hospital stay [3 (2.00, 6.50) d vs. 4 (3.00, 7.50) d, P = 0.001]. There was no statistically significant discrepancy in intermediate openings and complications in both groups (P > 0.05). CONCLUSION Compared with VATS, RATS is safety and effectivity in the treatment of mediastinal cysts and thus has advantages in operative time, intraoperative bleeding, postoperative chest drainage time and postoperative hospital stay.
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Affiliation(s)
- Ziqiang Hong
- The First Clinical Medical College of Gansu, University of Traditional Chinese Medicine, 35 East Dingxi Road, Lanzhou, Gansu, 730000, China
- First Department of Thoracic Surgery, Gansu Provincial Hospital, 204 Donggang West Road, Lanzhou, Gansu, 730000, China
| | - Yannan Sheng
- The First Clinical Medical College of Gansu, University of Traditional Chinese Medicine, 35 East Dingxi Road, Lanzhou, Gansu, 730000, China
| | - Baiqiang Cui
- The First Clinical Medical College of Gansu, University of Traditional Chinese Medicine, 35 East Dingxi Road, Lanzhou, Gansu, 730000, China
- First Department of Thoracic Surgery, Gansu Provincial Hospital, 204 Donggang West Road, Lanzhou, Gansu, 730000, China
| | - Xiangdou Bai
- The First Clinical Medical College of Gansu, University of Traditional Chinese Medicine, 35 East Dingxi Road, Lanzhou, Gansu, 730000, China
- First Department of Thoracic Surgery, Gansu Provincial Hospital, 204 Donggang West Road, Lanzhou, Gansu, 730000, China
| | - Tao Cheng
- The First Clinical Medical College of Gansu, University of Traditional Chinese Medicine, 35 East Dingxi Road, Lanzhou, Gansu, 730000, China
- First Department of Thoracic Surgery, Gansu Provincial Hospital, 204 Donggang West Road, Lanzhou, Gansu, 730000, China
| | - Yingjie Lu
- The First Clinical Medical College of Gansu, University of Traditional Chinese Medicine, 35 East Dingxi Road, Lanzhou, Gansu, 730000, China
| | - Xusheng Wu
- The First Clinical Medical College of Gansu, University of Traditional Chinese Medicine, 35 East Dingxi Road, Lanzhou, Gansu, 730000, China
- First Department of Thoracic Surgery, Gansu Provincial Hospital, 204 Donggang West Road, Lanzhou, Gansu, 730000, China
| | - Dacheng Jin
- First Department of Thoracic Surgery, Gansu Provincial Hospital, 204 Donggang West Road, Lanzhou, Gansu, 730000, China
| | - Yunjiu Gou
- First Department of Thoracic Surgery, Gansu Provincial Hospital, 204 Donggang West Road, Lanzhou, Gansu, 730000, China.
| | - Jing Zhao
- Lanzhou First People's Hospital, No.1 West Street Wujiayuan, Lanzhou, Gansu, 730000, China.
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Koliakos E, Kalogiannis E, Gussago S, Christodoulou M. Severe mediastinitis caused by an infected bronchogenic cyst. BMJ Case Rep 2023; 16:16/1/e253099. [PMID: 36639197 PMCID: PMC9843204 DOI: 10.1136/bcr-2022-253099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Bronchogenic cysts (BCs) are congenital foregut malformations and usually asymptomatic, thin-walled, incidentally diagnosed cysts which can be easily resected by a minimal invasive approach at this time point. However, they may develop symptoms such as infection, bleeding or compression of adjacent structures. There is no consensus about the risk of developing complications during a lifetime; however, recent reports suggest a higher incidence than initially believed. Here, we report a case of severe life-threatening mediastinitis emerging from an infected BC requiring complex surgery, which could have been avoided if surgery had been performed at an early, asymptomatic stage.
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Affiliation(s)
| | | | - Stefano Gussago
- General Surgery, Valais Romand Hospital Center, Sion, Switzerland
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Cooley-Rieders K, Van Haren RM. Mediastinal thymic cysts: a narrative review. MEDIASTINUM (HONG KONG, CHINA) 2022; 6:33. [PMID: 36582977 PMCID: PMC9792833 DOI: 10.21037/med-22-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 11/18/2022] [Indexed: 12/05/2022]
Abstract
Background and Objective Mediastinal thymic cysts are a relatively rare pathology. With the expansion of eligible individuals screened with cross-sectional imaging for lung cancer, it is likely that there will be an increase in the number of individuals presenting with these cysts. Understanding this rare pathology will become more important when this incidental pathology is encountered. Methods Search of PubMed was undertaken using keywords "mediastinal", "mediastinum", "thymic", "thymus", "cyst". Relevant literature was reviewed and selected for this comprehensive narrative review, including case reports, case series, and retrospective reviews. Key Content and Findings Thymic cysts in the mediastinum can be classified into two broad categories, congenital and inflammatory. Accurate diagnosis by imaging is challenging and the majority of patients are asymptomatic. Literature suggests that the majority of cysts are benign, however an unknown percentage may harbor neoplastic processes and over time can cause significant compressive symptoms. Definitive treatment and diagnosis is surgical, with overall excellent outcomes. The decision to pursue surgical treatment versus surveillance requires a shared decision making approach with patients. Conclusions Given the scarcity of available high quality evidence regarding the management of mediastinal thymic cysts, this review provides practitioners a broad knowledge base to guide patients to make informed decisions.
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Affiliation(s)
- Keaton Cooley-Rieders
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Robert M Van Haren
- Division of Thoracic Surgery, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Marcuse F, Rutten M, Schreurs R, Gietema HA, Theunissen P, Maessen JG. Symptomatic mediastinal mass in a 32-year-old male. Breathe (Sheff) 2021; 17:210029. [PMID: 34295427 PMCID: PMC8291925 DOI: 10.1183/20734735.0029-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/12/2021] [Indexed: 12/02/2022] Open
Abstract
A 32-year-old male, known to have atopic eczema, presented with a 3-day history of acute pleuritic chest pain and shortness of breath. No traumatic event had occurred. The pain was described as sharp and posture dependent, and was worse when leaning backwards. The patient had no palpitations, oedema or radiated pain. Dyspnoea was present both at rest and during exercise, without the presence of wheezing, haemoptysis or purulent sputum. He had no history of fever, cold shivers, weight loss or perspiration. His nutritional state was normal and he had no symptoms of nausea, vomiting or diarrhoea. For 3 days he had experienced dysphagia during meals. The patient was working full-time as a national courier and did not visit foreign countries for his work and did not travel outside Europe. The patient owned a dog but he had no specific contact with (farm) animals. He never smoked and never consumed alcohol. His physical condition, before the start of the present symptoms, was excellent due to daily exercises. On clinical examination our patient was conscious and orientated. He had a normal temperature of 36.9 °C, a respiratory rate of 16 breaths·min−1, blood pressure of 115/75 mmHg, heart rate of 68 beats·min−1 and an oxygen saturation of 95% on room air. Both percussion and respiratory sounds were reduced over the right hemithorax, without crackles or rhonchi. He had no pitting oedema around the ankles. A chest radiograph was performed (figure 1). Most bronchogenic cysts are found incidentally and clinicians should be aware of an atypical case presentation. Total surgical resection is the treatment of choice of a bronchogenic cyst, especially in symptomatic patients.https://bit.ly/3uQrFXo
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Affiliation(s)
- Florit Marcuse
- Dept of Pulmonology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Marijke Rutten
- Dept of Pulmonology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Rick Schreurs
- Dept of Cardiothoracic surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Hester A Gietema
- Dept of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Prisca Theunissen
- Dept of Pathology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Jos G Maessen
- Dept of Cardiothoracic surgery, Maastricht University Medical Center+, Maastricht, The Netherlands
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