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At least 37 records · Page 2Linked to original sources
PubMed1996

Mediastinal cyst involving the oesophagus: diagnosis and results of surgical treatment.

OBJECTIVE: To describe our experience with mediastinal cysts involving the oesophagus. DESIGN: Retrospective study. SETTING: University hospital, Italy. SUBJECTS: 11 patients who presented to our department with a mediastinal cyst from 1976-1994. INTERVENTIONS: Excision of the mass through a posterolateral thoracotomy (n = 10) or by video-assisted thoracoscopy. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: 8 patients presented with retrosternal or epigastric pain, three of whom had mild dysphagia. In the remaining 3 the tumour was asymptomatic and an incidental finding on a chest radiograph. Endoscopic ultrasonography and computed tomography (CT) allowed preoperative diagnosis of an extramucosal cyst in 5 of the 7 patients investigated by both tests. Masses were excised through a formal thoracotomy (n = 10) or by video-assisted thoracoscopy. Histological examination confirmed a benign cyst in all cases. There was no operative morbidity and nine patients are free of symptoms after a median follow-up of 2.3 years. CONCLUSION: Excision, preferably by thoracoscopy, is the treatment of choice for mediastinal cysts that involve the oesophagus. Special attention should be paid to the vagal nerves, and as many as possible of the muscular layers of the oesophagus should be preserved.

Adolescent↗
PubMed2002

Non-neoplastic mediastinal cysts.

OBJECTIVE: The non-neoplastic mediastinal cysts (NNMCs) form a group of uncommon benign lesions of a congenital origin. The significant controversy regarding these cysts is whether to manage with observation or surgical resection. The aim of this study is to analyse the utility of thoracic computed axial tomography (CT) in imaging diagnosis of the NNMCs and the results of surgery in these lesions. PATIENTS AND METHODS: Twenty NNMCs underwent surgery between 1980 and 2000. The preoperative study of mediastinal cystic masses includes a complete blood test, chest radiography (CR) and, for the last 15 years, a thoracic CT and/or nuclear magnetic resonance. All the patients underwent surgery in our thoracic surgery department and were reviewed in outpatients at 1 month, 6 months, 1 year and biannually thereafter. The form of manifestation, clinical features, imaging techniques, surgical operation, morbidity, mortality and follow-up are analysed. RESULTS: Ten corresponded to bronchogenic cysts, the most common symptom of which was chest pain. CR showed a mass in the anterior-superior mediastinum in nine cases, and CT (five cases) revealed a cystic tumour in the anterior mediastinum. All were removed surgically, with three patients presenting with mild complications. Seven corresponded to pleuro-pericardial cysts, four being asymptomatic. CR showed a right paracardial mediastinal tumour, which was confirmed by CT (four cases). All were removed surgically, with two patients presenting with mild complications. Three corresponded to enteric cysts. CR showed a tumour in the posterior mediastinum, with CT confirming its cystic nature (two cases). Excision of the cyst was done in all cases, which corresponded to duplication cysts: two oesophageal and one gastric. All the patients are asymptomatic and recurrence-free after a follow-up of 11 +/- 10 years. CONCLUSIONS: NNMCs are benign lesions in which the lesions in which the surgery can be done with a low morbidity and mortality rate, enables us to rule out malignancy and offers a definitive cure. Actually the thoracic CT permit a correct diagnosis pre-surgery in function of the radiologic characterisation and topography.

Adult↗
PubMed2004

Mediastinal cyst with rim calcification.

A 58-year-old man who had been undergoing treatment for chronic pericarditis for 15 months was found to have a calcified mediastinal mass shadow on a chest X-ray and was referred to us for further study and treatment. Chest computed tomography and magnetic resonance imaging showed an anterior mediastinal multilocular tumor with rim calcification. Tumor markers were within normal limits. The patient was preoperatively diagnosed as having a calcified mediastinal cyst, and median sternotomy was performed to remove the cystic tumor and the surrounding thymic tissues. Histological examination revealed that the cyst wall consisted of dense fibrous tissue and calcification without epithelial cell lining on the inner surface. Thymic tissue was present around the cyst wall. Although we suspected a thymic cyst from the intraoperative findings, the final diagnosis was made as mediastinal cyst with rim calcification. We herein present a rare case of mediastinal cyst with rim calcification.

Calcinosis↗
PubMedDate not supplied

Uncommon parathyroid mediastinal cyst compressing the trachea.

Mediastinal parathyroid cyst is a rare cause of space occupying lesion in the mediastinum. No specific symptomatology may be attributed to the non-functioning parathyroid cyst. The diagnosis is rarely made before exploration. The cysts are thin walled, smooth, of varying sizes and contained clear, opalescent or haemorrhagic fluid. Histopathological examination reveals clusters of parathyroid cells dispersed in the wall of the cyst. Surgical removal is the treatment of choice and can be performed with minimal morbidity.

Cysts↗
PubMed1993

Thoracoscopic resection of mediastinal cysts.

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.

Bronchogenic Cyst↗
PubMed1980

[Enteric mediastinal cysts in children (author's transl)].

Primary mediastinal tumors are rare, especially in children, one fifth of them being cystic. Clinical and radiographic findings in 7 patients with mediastinal cysts are reported. Emphasis is placed upon the role of the radiologist to properly place the lesion into one of the three compartments of the mediastinum, which should even be possible for a mass in the upper mediastinum--above the line of capeabody. If a mass is established as belonging to the middle mediastinum, then there the probability is high of it being cystic and benign; and aggressive extensive radiographic workup can be spared preoperatively without significant risk to the patient.

Child↗
PubMed2002

[Multicenter experience of video-assisted thoracic surgery to treat mediastinal cysts and tumors].

OBJECTIVE: In spite of improvements in imaging techniques, surgical procedures are often needed to diagnose and definitively treat mediastinal masses. The range of application of video-assisted thoracic surgery (VATS) in this context is still poorly defined. The present study describes and analyzes the experience of the Cooperative Group for Video-assisted Thoracoscopic Surgery of the Spanish Society of Pneumology and Thoracic Surgery (GCCVT-SEPAR), with the aim of determining the usefulness of the technique for treating mediastinal cysts and tumors. METHOD: For 2 years we gathered information prospectively on 1,573 consecutive VATS procedures in 17 hospitals. The data from 64 procedures performed for diagnosis and treatment of mediastinal cysts and tumors are analyzed. RESULTS: A definitive diagnosis was reached in all cases. Nineteen were malignant tumors and 45 were benign lesions. Twenty-five complete resections (39%) were performed: 6 pleuropericardial cysts, 4 bronchogenic cysts, 8 neurogenic tumors and other benign lesions. Radiologically poorly defined masses and those located in the anterior and median parts of the mediastinum were most often the object of diagnostic procedures, whereas cysts and well-defined solid lesions on the posterior mediastinum were usually the object of therapeutic interventions. Eleven percent of the cases required conversion to thoracotomy, mainly due to pleural adhesions. Four complications (6.3%) were recorded and no deaths occurred. The median hospital stay after surgery was 2.5 days; 7.8% of the procedures were performed on outpatients. CONCLUSIONS: VATS is performed on many mediastinal lesions in Spain. Cysts and benign tumors are selected for resection. Poorly defined and malignant lesions were diagnosed by biopsy. The experience reported demonstrates the efficacy and safety of this technique for selected cases.

Adolescent↗
PubMed1982

[Mediastinal cysts].

In the department of thoracic surgery of the Kostroma Region Hospital from 1967 to 1980 thirty one patient were operated upon for mediastinal cyst. Most of the patients did not have any complaints at the admission, clinical symptoms of the others having not characteristic picture. The mediastinal cysts should be treated only surgically. Results of operations were good.

Adolescent↗
PubMed1998

Thoracoscopic treatment of mediastinal cysts in children.

BACKGROUND/PURPOSE: The development of thoracoscopic surgery has made many procedures possible, including the treatment of mediastinal cysts in children. The authors report their experience with this procedure between 1992 and 1997. METHODS: Surgery was performed on 22 children aged from 1 month to 9 years (median, 27 months), weighing 5 to 49 kg (median, 12.5 kg). Diagnosis was made by antenatal ultrasound scan in six cases (27%), with a chest x-ray performed for respiratory symptoms in 14 cases, and with a chest x-ray performed for positive tuberculin intradermoreaction in two cases. Decision to resect the cyst was determined by thoracoscopy in 21 of the 22 cases, and by open surgery in one case only (subcarinal compressive cyst with left lung distension and a mediastinal shift). RESULTS: Eighteen of the 21 (86%) cases were treated successfully by thoracoscopy. In three cases of bronchogenic cysts, we performed an associated thoracotomy because the dissection was too difficult and dangerous. In three cases, a small part of a common wall between the cyst and the bronchus was not removed. The pathological diagnosis was bronchogenic cysts in 15 cases (71%), pleuropericardiat cysts in three cases (14%), esophageal duplication in two cases (10%), and cystic hygroma in one case (5%). Two postoperative complications were observed: one esophageal wound and a case of recurrent pneumothorax after chest tube removal. Patients were discharged after 2 to 11 days (median, 3 days). Follow-up was uneventful. CONCLUSIONS: Treatment of mediastinal cyst by thoracoscopy is feasible in most cases. Compressive cysts with lung distension and mediastinal shift remain a contraindication. If the cysts have a common wall with the bronchus or esophagus, or if they are subcarinal, the dissection may be difficult and dangerous, and thoracotomy may be preferable.

Child↗
PubMed1975

[Transbronchial puncture and instillation of contrast medium for the radiographic visualization of a mediastinal cyst (author's transl)].

A new method for preoperative diagnosis of mediastinal cysts is described. A transbronchial puncture of a mediastinal cystic tumor was performed in one patient with a mediastinal enlargement and stenosis of the right main bronchus. Afer aspiration of fluid material a water-soluble contrast medium was instilled under fluoroscopic control via a normal biopsy needle. Summarizing their experiences the indications for this new technique is discussed.

Adult↗
PubMed1990

[Three cases of occult thyroid cancer with mediastinal lymph node metastasis manifesting as a mediastinal cyst].

We experienced three cases (one 38-year-old male, 58-year-old and 67-year-old females) whose resected mediastinal cysts proved to be metastatic lymph nodes from occult thyroid cancer. Primary lesions in thyroid gland were detected by echography in all three cases though they were detected in one case out of two by CT, in one out of three by 201T1 scintigraphy, in two out of three by 123I scintigraphy. After these examinations on thyroid gland, operations (one lobectomy, one hemithyroidectomy, one total thyroidectomy) were performed. Primary lesions in thyroid gland were all papillary carcinomas, and ranged 4 x 3 mm to 12 x 10 mm in size. Multiple foci were found in two cases, many intrathyroidal metastases in one case, cervical lymph node metastases in two cases. In cases of mediastinal cyst, thyroid gland should be examined by echography paying attention to the mediastinal lymph node metastasis from occult thyroid cancer. When occult thyroid cancer with mediastinal lymph node metastasis is diagnosed, total thyroidectomy followed by 131I radiation therapy is recommended as the treatment for a primary lesion, because of multiple foci in thyroid gland and intrathyroidal metastases.

Adult↗
PubMedDate not supplied

Mediastinoscopy in the treatment of mediastinal cysts.

OBJECTIVE: Primary cysts constitute 25% of all masses in the mediastinum. Because radiological investigations are often inconclusive, many adults require mediastinoscopy, thoracotomy, video-assisted thoracic surgery, or computed tomography-guided transbronchial, transesophageal, or transcutaneous aspiration to confirm the cystic nature of these lesions. Minimally invasive procedures fail when the cyst contents are gelatinous and mucoid (failure to aspirate) or when the cyst wall continues to secrete fluid. Though Pursel reported mediastinoscopic extirpation of benign cysts 35 years ago, it remains a "therapeutic curiosity" with sporadic reports of its usage. We report 2 successful mediastinal cyst extirpations performed as outpatient procedures and review the literature with regards to its management. METHODS: A rigid, 8-mm mediastinoscope was inserted into the anterior mediastinum following the creation of a 2-cm suprasternal incision and dissection along the anterior surface of the trachea. After aspiration, cytology of the contents revealed their benign nature. Right paratracheal cysts in 2 adult males were successfully removed mediastinoscopically by blunt and sharp dissection. RESULTS: Histopathology revealed benign mesothelial cysts in both instances. Both patients had an uncomplicated procedure and were discharged within 23 hours. No other pathology was detected on mediastinoscopy, and follow-up at 3 months and 6 months has revealed no recurrence. CONCLUSION: Mediastinoscopic cyst removal is a minimally invasive procedure with a very low morbidity and mortality rate. Morbidity, recovery, and discharge times are much less than those of more invasive procedures (video-assisted thoracic surgery / thoracotomy). We suggest that it should be the first-choice procedure for the excision of appropriately located benign mediastinal cysts.

Aged↗
PubMed1993

[Thirty-eight operative cases of mediastinal cyst: with particular reference to bronchogenic cyst].

Thirty-eight patients (16 males and 22 females) with mediastinal cysts have been treated at the Second Department of Surgery at Okayama University from 1978 to 1989. There were thirteen cases of thymic cyst, nine cases of pericardial cyst one case of pericardial diverticulum, eight cases of bronchogenic cyst, two cases of dermoid cyst, two cases of cystic lymphangioma, one case of esophageal cyst, one case of gastroenteric cyst, and one case of aneurysmal bone cyst. MRI seemed to be useful for the qualitative diagnosis of mediastinal tumors as cystic or solid. Based on Maier's classification and considering the result of this study, bronchogenic cysts may be divided into the following groups: 1) paratracheal, 2) carinal, 3) hilar, 4) paraesophageal [a) upper (Iu), b) lower (Im, Ei)], 5) cephalad recess of the azygos vein (CRAzV) and 6) miscellaneous. According to this new classification, these bronchogenic cysts could be allocated to (3) hilar: 1 cyst, (4-a) paraesophageal-upper: 1 cyst, (4-b) paraesophageal-lower: 1 cyst, (5) CRAzV: 4 cysts, and (6) miscellaneous: 2 cysts.

Adolescent↗