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Sadrizadeh A, Bagheri R, Afghani R, Molaei M. Video-assisted mediastinoscopic resection of mediastinal cyst (lymphangioma). Asian Cardiovasc Thorac Ann 2014; 22:1119-21. [PMID: 24887894 DOI: 10.1177/0218492313505749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mediastinal cysts account for 20% of all mediastinal masses. Symptomatic cysts need treatment, and surgical excision is the treatment of choice. One approach to resect them is video-assisted mediastinoscopy. An 80-year-old man with cough and dyspnea at rest was referred for evaluation. Chest computed tomography revealed a mediastinal cyst. Because of his symptoms, he was a candidate for surgery, and the cyst was resected by video-assisted mediastinoscopy through a cervical incision. Video-assisted mediastinoscopy is a safe and effective approach for complete resection of mediastinal cysts.
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Affiliation(s)
- Ali Sadrizadeh
- Cardiothoracic Surgery and Transplant Research Center, Qaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Bagheri
- Cardiothoracic Surgery and Transplant Research Center, Qaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Reza Afghani
- Cardiothoracic Surgery and Transplant Research Center, Qaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehdi Molaei
- General Surgery Department, Zahedan University of Medical Sciences, Zahedan, Iran
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Ubukata H, Satani T, Motohashi G, Konishi S, Goto Y, Watanabe Y, Nakada I, Tabuchi T. Intra-abdominal bronchogenic cyst with gastric attachment: report of a case. Surg Today 2011; 41:1095-100. [PMID: 21773899 DOI: 10.1007/s00595-010-4398-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2010] [Accepted: 03/23/2010] [Indexed: 12/12/2022]
Abstract
We report a rare case of an intra-abdominal bronchogenic cyst. An abnormal lesion was detected on an ultrasonogram, done as part of a physical checkup, in an 81-year-old woman. Computed tomography and magnetic resonance imaging showed a cystic mass attached to the lesser curvature of the stomach. Initially, we suspected a congenital cyst without malignant components; however, as the patient wished to have the lesion removed, we performed a minilaparotomy. The cystic lesion was firmly attached to the lesser curvature by fibrous tissue. Microscopic examination subsequently revealed the 26-mm mass to be a benign bronchogenic cyst with a bronchial element. We compared our findings with those of 50 previously reported cases of intraabdominal bronchogenic cysts. None of these patients was older than ours, and lesions attached to the esophagus or stomach were extremely unusual. Bronchogenic cysts are difficult to diagnose preoperatively based on imaging findings, but surgery may be indicated if malignant components are suspected, or if the lesion is enlarging or causing symptoms.
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Affiliation(s)
- Hideyuki Ubukata
- Fourth Department of Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, Ami, Inashiki, Ibaraki, 300-0395, Japan
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Casal RF, Jimenez CA, Mehran RJ, Eapen GA, Ost D, Sarkiss M, Morice RC. Infected mediastinal bronchogenic cyst successfully treated by endobronchial ultrasound-guided fine-needle aspiration. Ann Thorac Surg 2010; 90:e52-3. [PMID: 20868780 DOI: 10.1016/j.athoracsur.2010.06.062] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 05/26/2010] [Accepted: 06/10/2010] [Indexed: 11/19/2022]
Abstract
Bronchogenic cysts are one of the most common bronchopulmonary congenital malformations found in adults. Most authors agree that symptomatic or infected cysts should be surgically removed. We report our experience in which we treated an infected mediastinal bronchogenic cyst with a combination of antibiotics and drainage by endobronchial ultrasound-guided fine-needle aspiration, with resolution of symptoms and no evidence of recurrence after an 18-month follow-up.
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Affiliation(s)
- Roberto F Casal
- Department of Pulmonary and Critical Care Medicine, Baylor College of Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
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Le Pimpec-Barthes F, Cazes A, Bagan P, Badia A, Vlas C, Hernigou A, Pricopi C, Riquet M. [Mediastinal cysts: clinical approach and treatment]. REVUE DE PNEUMOLOGIE CLINIQUE 2010; 66:52-62. [PMID: 20207297 DOI: 10.1016/j.pneumo.2009.12.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 12/17/2009] [Indexed: 05/28/2023]
Abstract
Mediastinal cysts (MC), mainly from embryonic origin, are benign and rare malformative lesions, gathering several varieties according to tissue origin. Diagnosis is mostly obtained thanks to tomodensitometry performance and sometimes by magnetic resonance imaging. It may be more difficult in some atypical topographies and in case of bulky MC. The most frequent, springing from division abnormality from embryonic foregut ("foregut cysts" in English literature), are primarily bronchogenic cysts (50 to 60 % of MC), which are symptomatic in 30 to 80 % of cases. Coelomic cysts, lined by a mesothelium, result from embryologic abnormality by incomplete fusion of mesenchymal coelomic lacunae. Rarely symptomatic, excepted in cases of very large cysts, they are mainly pleuropericardic cysts (PPC) that represent 30 % of MC. Thymic cysts, around 15 % of MC, are most often asymptomatic. Cystic lymphangiomas (CL) are congenital lymphatic malformations more frequent and symptomatic in children. Diagnosed in older patients, they are most often acquired and asymptomatic. The only radical and definitive treatment is complete surgical resection of the cyst. It allows suppression of symptoms, procurement of a formal diagnosis and prevention of complications. This resection, generally indicated for all symptomatic cysts, large-sized even asymptomatic and in case of non formal diagnosis, is now recommended for all kinds of cysts except for asymptomatic PPC. This strategy is justified considering morbidity and mortality rising rates in patients treated by surgical resection at time of local complications of the cyst. Surgery is commonly performed by videothoracoscopy or by video-assisted mini-thoracotomy, mainly for PPC and CL. The more conventional thoracotomy is performed in surgery for cysts, which are adhesive to nearby structures. PPC just need a simple follow-up, and surgery is required only in case of symptoms and increasing size. In total, surgical indications for MC are large and accepted because of null postoperative mortality and very low rate of morbidity thanks to mini-invasive surgery. This militates for early surgery, without waiting for cystic complications leading to peroperative difficulties and increasing risks. This review presents the characteristics of those different cysts and the strategies currently acknowledged for the treatment.
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Affiliation(s)
- F Le Pimpec-Barthes
- Service de Chirurgie Thoracique, Hôpital Européen Georges-Pompidou, 20 rue Leblanc, 75908 Paris cedex 15, France.
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Nakajima T, Yasufuku K, Shibuya K, Fujisawa T. Endobronchial ultrasound-guided transbronchial needle aspiration for the treatment of central airway stenosis caused by a mediastinal cyst. Eur J Cardiothorac Surg 2007; 32:538-40. [PMID: 17629489 DOI: 10.1016/j.ejcts.2007.06.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2007] [Revised: 06/05/2007] [Accepted: 06/11/2007] [Indexed: 11/19/2022] Open
Abstract
Central airway stenosis caused by compression due to mediastinal cyst is rare. Direct real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive method for tissue sampling of the mediastinum. Using this new therapeutic modality, the mediastinum can be punctured repeatedly and safely under local anesthesia with real-time guidance. Cystic lesions are easily detectable, and the Doppler mode helps to distinguish the cystic lesion from vascular structures. We herein report a rare case of central airway stenosis caused by mediastinal cyst successfully treated by EBUS-TBNA with no regrowth after 1 year. A total of 80 ml of fluid content was aspirated, resulting in patency of the trachea.
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Affiliation(s)
- Takahiro Nakajima
- Department of Thoracic Surgery, Graduate School of Medicine, Chiba University, Japan
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De Baets F, Van Daele S, Schelstraete P, Haerynck F, Vermassen F, Broers C. Asphyxiating tracheal bronchogenic cyst. Pediatr Pulmonol 2004; 38:488-90. [PMID: 15514990 DOI: 10.1002/ppul.10408] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We report on a 7-month old infant with severe respiratory distress secondary to a paratracheal bronchogenic cyst. Respiratory relief was achieved by transtracheal puncture of the cyst. Surgical removal of the cyst was performed 1 week later because of radiological evidence of reaccumulation of fluid.
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Affiliation(s)
- F De Baets
- Department of Pediatrics, University Hospital Ghent, De Pintelaan 185, 9000 Ghent, Belgium.
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Abstract
Preoperative diagnosis of paraesophageal bronchogenic cysts is difficult, and its management remains controversial. We describe the case of an incidental paraesophageal bronchogenic cyst, suspected preoperatively with endoscopic ultrasound and established intraoperatively by thoracoscopic inspection. Surgical treatment was achieved by cyst excision using a needlescopic technique. Endoscopic ultrasound seems to be the preoperative diagnostic test of choice for paraesophageal bronchogenic cysts.
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Affiliation(s)
- Li Lin Lim
- Department of Medicine, National University Hospital, Singapore
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Abstract
STUDY OBJECTIVE Evaluate the use of mediastinoscopy in the surgical diagnosis and treatment of mediastinal cystic masses in adults. DESIGN Case reports and literature review. SETTING Academic department of surgery. PATIENTS Three consecutive adults with mediastinal masses identified on plain radiographs and CT. INTERVENTIONS Operative mediastinoscopy. MEASUREMENTS AND RESULTS All patients were successfully treated with removal of cyst wall, establishment of diagnosis, and same-day hospital discharge. CONCLUSIONS Simple mediastinoscopic removal of mediastinal cysts offers the same potential for diagnosis and treatment as more conventional methods, with a potential for less morbid and more cost-effective care.
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Affiliation(s)
- W R Smythe
- Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, USA
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Faigel DO, Burke A, Ginsberg GG, Stotland BR, Kadish SL, Kochman ML. The role of endoscopic ultrasound in the evaluation and management of foregut duplications. Gastrointest Endosc 1997; 45:99-103. [PMID: 9013183 DOI: 10.1016/s0016-5107(97)70315-8] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- D O Faigel
- Department of Medicine, University of Pennsylvania Health System, Philadelphia, USA
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Abstract
Flexible fiberoptic bronchoscopy (FFB) has become common practice for pediatric pulmonologists, allowing easier detection of certain abnormalities at an earlier stage. We report the endoscopic diagnosis of a large mediastinal bronchogenic cyst and its successful endoscopic unroofing in a symptomatic baby.
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Affiliation(s)
- I Dab
- Department of Pediatrics, AZ VUB, Brussels, Belgium
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Patel SR, Meeker DP, Biscotti CV, Kirby TJ, Rice TW. Presentation and management of bronchogenic cysts in the adult. Chest 1994; 106:79-85. [PMID: 8020324 DOI: 10.1378/chest.106.1.79] [Citation(s) in RCA: 114] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Bronchogenic cysts are congenital anomalies of the bronchial tree that are often asymptomatic at presentation in adults. Management of asymptomatic bronchogenic cyst in this population remains controversial. Eighteen patients with bronchogenic cysts were treated at our institution since 1975. At initial presentation, 10 patients (56 percent) were asymptomatic and 8 (44 percent) were symptomatic. Cough and pain were the most frequent symptoms. Two patients presented with potentially serious complications, one with respiratory distress from airway compression and the other with infection and airway fistulae. Chest radiographs were abnormal but nondiagnostic in 17 out of 18 (94 percent) patients. Chest computerized tomography (CT) scans were abnormal in eight of eight (100 percent) patients, but they confirmed the benign cystic nature in only five of eight (62.5 percent). Overall, considering the use of all imaging modalities and clinical suspicion, bronchogenic cyst was considered in the preoperative differential diagnosis in only 11 of 18 (61 percent) patients. Fifteen of 18 cysts were resected initially. Three of the asymptomatic patients who were followed up initially ultimately required resection because of the development of symptoms. A trend toward increased postoperative complications was noted in patients who were symptomatic at the time of surgery (27 percent vs 14 percent). In conclusion, adult patients with asymptomatic bronchogenic cyst may develop symptoms over time. Symptoms in adults can sometimes be potentially serious. Since a confident preoperative diagnosis is not always possible and because surgical complications may be more common in the symptomatic patient, we recommend surgical resection of all suspected bronchogenic cysts in operable candidates.
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Affiliation(s)
- S R Patel
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Foundation, Ohio 44195
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Abstract
Thoracoscopy would seem to have several potential advantages over open techniques in terms of the attendant postoperative pain and pulmonary complications. Although many questions exist pertaining to the use of thoracoscopy in the therapeutic management of malignancies of the mediastinum, its use for benign disorders appears desirable. Since December 1990, we have removed 9 mediastinal cysts using a thoracoscopic procedure. These included 7 bronchogenic or enteric cysts, 1 pericardial cyst, and 1 thymic cyst. The average cyst size was 4.2 cm, with 11 cm the largest diameter. Complete removal of the cysts was possible in all but 1 case, in which the cyst adhered to vital structures. A portion of the cyst wall was therefore left intact and the mucosa cauterized. The average hospital stay in these patients was 2.1 days, and there were no intraoperative or postoperative complications. All cysts were benign. The resection of mediastinal cyst using thoracoscopic procedures and based on standard surgical indications would seem to be appropriate. Thoracoscopic removal should be considered as an alternative method to resection of mediastinal cysts.
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Affiliation(s)
- S R Hazelrigg
- Southern Illinois University School of Medicine, Springfield 62794-9230
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