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Miyamoto H, Lee S, Ishidate T, Kuroda K, Kasashima H, Miki Y, Yoshii M, Fukuoka T, Tamura T, Shibutani M, Toyokawa T, Maeda K. A case of a thoracic duct cyst extending from the mediastinum to the cisterna chyli resected using bilateral thoracoscopic surgery in the prone position. Surg Case Rep 2023; 9:171. [PMID: 37747542 PMCID: PMC10519914 DOI: 10.1186/s40792-023-01740-6] [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: 07/05/2023] [Accepted: 08/28/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND Thoracic duct cysts are extremely rare mediastinal tumors. We report a case of a thoracic duct cyst extending from the caudal aspect of the left main bronchus to the left renal artery that was safely and completely resected via bilateral thoracoscopic surgery in the prone position. CASE PRESENTATION A 77-year-old male was referred to our hospital for follow-up computed tomography (CT) of prostate cancer, which revealed a mediastinal tumor and fatty low-density along the posterior mediastinum of the para-aortic artery with a slightly high-density component. Magnetic resonance imaging revealed a T2-weighted image with high intensity. The preoperative radiological diagnosis was lipoma or well-differentiated liposarcoma. CT in the prone position suggested that the tumor could be resected from the thoracic cavity to the caudal side, and bilateral thoracoscopic surgery was performed in the prone position. Based on the surgical findings, the tumor was diagnosed as a thoracic duct cyst rather than a lipoma. Dissection around the thoracic duct cyst was performed using a vessel-sealing system to prevent leakage of the chyle, and reliable clipping was performed to resect the cisterna chyli. Histopathological examination revealed smooth muscle structures around the cyst, suggestive of a thoracic duct cyst. The diagnosis of a thoracic duct cyst was made based on a high triglyceride level of 1310 mg/dL on examination of the milky-white cyst fluid. The patient's postoperative course was uneventful, and he was discharged 4 days postoperatively. A CT scan performed 13 months after surgery showed no recurrence. CONCLUSIONS A rare thoracic duct cyst extending from the mediastinum to the cisterna chyli was safely and completely resected using bilateral thoracoscopic surgery, with the patient in the prone position.
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Affiliation(s)
- Hironari Miyamoto
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno, Osaka 545-8585 Japan
| | - Shigeru Lee
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno, Osaka 545-8585 Japan
| | - Takemi Ishidate
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno, Osaka 545-8585 Japan
| | - Kenji Kuroda
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno, Osaka 545-8585 Japan
| | - Hiroaki Kasashima
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno, Osaka 545-8585 Japan
| | - Yuichiro Miki
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno, Osaka 545-8585 Japan
| | - Mami Yoshii
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno, Osaka 545-8585 Japan
| | - Tatsunari Fukuoka
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno, Osaka 545-8585 Japan
| | - Tatsuro Tamura
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno, Osaka 545-8585 Japan
| | - Masatsune Shibutani
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno, Osaka 545-8585 Japan
| | - Takahiro Toyokawa
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno, Osaka 545-8585 Japan
| | - Kiyoshi Maeda
- Department of Gastroenterological Surgery, Osaka Metropolitan University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno, Osaka 545-8585 Japan
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Hsu DS, Banks KC, Velotta JB. Surgical approaches to mediastinal cysts: clinical practice review. MEDIASTINUM (HONG KONG, CHINA) 2022; 6:32. [PMID: 36582973 PMCID: PMC9792838 DOI: 10.21037/med-22-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/08/2022] [Indexed: 11/06/2022]
Abstract
The traditional approach to mediastinal cyst and mass resection has been open via median sternotomy or thoracotomy. With the advent of minimally invasive techniques, there have been successful cases completed via video-assisted thoracoscopic (VATS) and robot-assisted thoracoscopic surgery (RATS). Although mediastinal cysts are uncommon, they are a significant and relevant topic in the practice of thoracic surgery. Thus, this clinical practice review aims to summarize and highlight some of the key case series and retrospective studies in order to provide insight on each of the approaches. In addition, there is a brief review of other approaches, such as subxiphoid, and the utility of endobronchial ultrasound in the management of mediastinal cysts. In this review, the identified benefits of VATS and RATS lie largely in quality improvement of the patient experience-decreased length of stay (LOS) and pain-without compromising patient outcomes. However, the open approach remains a viable option, particularly for the management of large cysts or as a bail-out option. When surgeons approach with VATS or RATS and encounter bleeding or difficult dissection planes, it is consistent in the literature that conversion to thoracotomy is the safe next step. Our clinical practice is to attempt VATS or RATS approach for mediastinal cysts when possible. The data used for this review relies heavily on case reports and case series, and thus is the main limitation of this clinical practice review.
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Affiliation(s)
- Diana S. Hsu
- UCSF East Bay Surgery, Highland Hospital, Oakland, CA, USA;,Department of Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Kian C. Banks
- UCSF East Bay Surgery, Highland Hospital, Oakland, CA, USA;,Department of Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Jeffrey B. Velotta
- Department of Surgery, Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
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Alrashidi I, Shin JH. Percutaneous Transhepatic and Translumbar Sclerotherapy of a Thoracic Duct Cyst: A Case Report. THE ARAB JOURNAL OF INTERVENTIONAL RADIOLOGY 2021. [DOI: 10.1055/s-0041-1730116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractA 58-year-old male presented with chronic abdominal pain lasting 5 years and a 15 × 6-cm multicystic thoracic duct cyst with three compartments, located in the right retrocrural and retrocardiac regions from T5/T6 to T12/L1. A transhepatic route was selected to sclerose the middle and lower compartments. Subsequent contrast injection showed minimal contrast passage into the upper compartment through a narrow neck, but the guidewire could not pass into this compartment. The contrast-filled upper compartment was punctured with a 22-g Chiba needle using a translumbar approach under cone-beam computed tomography (CT) guidance and ethanol sclerotherapy was performed. Six-month follow-up CT revealed decreased thoracic duct cyst size (5×3 cm) and no pain. This case illustrates successful percutaneous transhepatic and translumbar sclerotherapy for retrocardiac and retrocrural thoracic duct cysts, which are very difficult to remove surgically.
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Affiliation(s)
- Ibrahim Alrashidi
- Department of Radiology, University of Ulsan, College of Medicine Asan Medical Center, Songpa-gu, Seoul, Republic of Korea
| | - Ji Hoon Shin
- Department of Radiology, University of Ulsan, College of Medicine Asan Medical Center, Songpa-gu, Seoul, Republic of Korea
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Garner M, Duvva D, Gosney J, Buderi S. Spontaneousrupture of a giant thoracic duct cyst presenting with abdominal pain and a tension chylothorax. Interact Cardiovasc Thorac Surg 2021; 31:732-733. [PMID: 32984883 DOI: 10.1093/icvts/ivaa177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 07/26/2020] [Indexed: 11/15/2022] Open
Abstract
Ruptured thoracic duct cysts are an extremely rare occurrence that may arise spontaneously or due to trauma. Surgical treatment is needed to provide a definitive diagnosis, drain the chylothorax and ligate the thoracic duct to prevent reoccurrence. We report the case of a woman with a ruptured thoracic duct cyst presenting with abdominal pain and subsequent tension chylothorax. To the best of our knowledge, this is the first such reported case.
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Affiliation(s)
- Megan Garner
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Dileep Duvva
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - John Gosney
- Department of Pathology, Royal Liverpool Hospital, Liverpool, UK
| | - Silviu Buderi
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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Azmeen A, McArdle JR, Foster JE, Shaik A. To Be or Not To Be: A Case of Recurrent Swelling Syndrome of Thoracic Duct. JACC Case Rep 2020; 2:1070-1073. [PMID: 34317417 PMCID: PMC8302103 DOI: 10.1016/j.jaccas.2020.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/28/2020] [Accepted: 05/06/2020] [Indexed: 11/24/2022]
Abstract
Thoracic duct aneurysm is a rare entity presenting as a stable, asymptomatic, left supraclavicular swelling. We report an unusual case of a thoracic duct aneurysm in a 71-year-old woman presenting as a recurrent swelling syndrome of the left supraclavicular area associated with sporadic episodes of sharp left subcostal pain. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Ayesha Azmeen
- Department of Internal Medicine, University of Connecticut, Farmington, Connecticut
| | - John R McArdle
- Pulmonology and Critical Care, Hartford Hospital, Hartford, Connecticut
| | | | - Ayesha Shaik
- Department of Internal Medicine, University of Connecticut, Farmington, Connecticut
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Abstract
A 69-year-old male presented with back tightness. Computed tomography revealed a 5 cm × 3 cm cystic para-oesophageal mass. A right robotic-assisted thoracoscopic resection was performed. Final pathology revealed a thoracic duct cyst (TDC). Robotic resection of a TDC has not been described in the literature previously but is shown in this report to be an effective and efficient way to perform the procedure. We suspect that robotic resection of mediastinal masses such as TDCs will become more common. Further studies comparing robotic to non-robotic resection of mediastinal masses would be helpful to determine the preferred treatment while minimising morbidity, length of stay and cost.
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Affiliation(s)
- Michael Andrew Napolitano
- Department of Surgery, Division of Thoracic Surgery, The George Washington University Hospital, Washington, DC, USA
| | - Keith D Mortman
- Department of Surgery, Division of Thoracic Surgery, The George Washington University Hospital, Washington, DC, USA
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Zampieri D, Marulli G, Mammana M, Calabrese F, Schiavon M, Rea F. An Unusual Cause of Thoracic Outlet Syndrome. Heart Lung Circ 2016; 25:e162-e164. [DOI: 10.1016/j.hlc.2016.06.1207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 06/08/2016] [Accepted: 06/10/2016] [Indexed: 10/21/2022]
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