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[Mediastinal cysts].

Mediastinal cysts, described also as homoplastic dysembryomas, account for 20% of mediastinal lesions. There are bronchogenic, oesophageal, gastrogenic and enterogenic, pericardial, non-specific cysts and cystic lymphangiomas. The authors present 6 patients with mediastinal cysts from a total number of 96 patients with mediastinal tumours subjected to surgery during a 14-year period (from Jan. 1 1987 to Dec. 31 2001). The group comprised 5 adults and one child. In four patients the authors selected thoracotomy as the route of access to the mediastinum, in one instance total sternotomy and once upper partial sternotomy. The cysts were removed as a whole. Histological examination revealed in four patients the diagnosis of a bronchogenic cyst, once a connective tissue cyst with respiratory epitheliumm and once a cyst lined with squamous epithelium. The postoperative course was in all patients free from complications. In the conclusion the authors emphasize the importance of complete removal of mediastinal cysts as relapses occur if part of the secretory eoithelium is not removed.

Adolescent↗

[Considerations in the surgical treatment of enterogenic mediastinal cyst].

INTRODUCTION: Mediastinal alterations causing esophageal dysfunctions originate from malignant or inflammatory diseases and in a few cases from congenital anomalies. CASE REPORT: The authors report the medical history of a 27-year-old woman whose large (35-40 mm in diameter) cystic lesion was causing compression of the middle third esophagus and dysphagia. Because of subjective complaints resection was made from a right posterolateral "muscle-preserving" thoracotomy. Histological examination verified an intramural, esophageal cyst. After the 7th postoperative day the patient was discharged from the hospital, currently she is without symptoms and complaints. DISCUSSION: In the background of esophageal dysfunctions can be a mediastinal lesion causing external compression. This lesion, in a few cases, is a congenital anomaly, which develops during the separation of the respiratory- and the digestive apparatus. Probably the effect of increased divisional tendency can create the partial duplication of developing organs, i.e. trachea, esophagus. Later these are described as bronchogenic or enterogenic cysts. Literature mentions cases about ciliated columnal epithelium, ventricular mucosa or malignancy covering the inner surface of the cyst. Preoperative examinations are not enough to describe a mediastinal cyst. According to the surgical guidelines a case without complaints is only a relative indication to operate. If it is followed, an occasional malignant transformation will not be recognized, or will be recognized too late. CONCLUSION: As we know, a mediastinal cystic lesion never regresses. Because of the tendency of malignant transformation, in the absence of operative contraindication, surgical resection is the method of choice even in symptom-free cases.

Adult↗

Displacement of the heart by a giant mediastinal cyst.

A giant mediastinal cyst caused marked cardiac displacement, factitious cardiomegaly and clinical and hemodynamic findings suggestive of constrictive pericarditis. The correct diagnosis was established with echocardiography and confirmed with angiography and surgery.

Cardiomegaly↗

Percutaneous fine needle aspiration in the diagnosis and management of mediastinal cysts in adults.

Management of asymptomatic mediastinal cysts in adults is controversial. In the past, these cysts were excised primarily to establish a diagnosis. Presently, computerized tomography (CT) of the chest can diagnose the majority of mediastinal cysts, based on their smooth contour and low density; however, CT diagnosis of a mediastinal cyst based on density can be erroneous. In six patients, we established the diagnosis of mediastinal cyst by percutaneous needle biopsy (PNB) without complication. In four of the patients, PNB was done as an outpatient procedure. Follow-up in five patients ranged from three months to three years, with no increase in the size of the cyst; in the sixth patient, surgical excision showed a hygroma. Thus, diagnosis of a mediastinal cyst can be safely confirmed by PNB. We suggest that these asymptomatic patients can be followed up without the need for surgical excision.

Adult↗

Balloon catheter for cyst aspiration in a thoracoscopic resection of mediastinal cysts.

In a thoracoscopic resection of mediastinal cysts, aspiration of the cyst contents at the beginning of the procedure is often helpful because it allows the cyst to be more easily grasped and manipulated. Spillage of the cyst contents into the thoracic cavity may, however, occur during aspiration when an ordinary aspiration needle is used. If the cyst contents are infective, then a subsequent contamination of the thoracic cavity may develop. We therefore use a specially designed double-balloon catheter for aspiration to minimize spillage of the cyst contents into the thoracic cavity. We describe herein the usefulness of this aspiration technique.

Catheterization↗

Mediastinoscopic treatment of mediastinal cysts.

Selected patients with mediastinal cysts can be managed safely and effectively by mediastinoscopic techniques. Small cysts in favorable locations can be excised partially or nearly completely. Cysts that are intimately associated with vital structures are better suited to mediastinoscopic cystotomy and chemical sclerosis. Three cases are presented and technical aspects are discussed.

Adult↗

[Endodermal and coelomic mediastinal cysts].

Eight cases of mediastinal cysts of endodermic and celomatic origin were operated on at Istituto di Chirurgia Generale e Cardiovascolare, University of Milano: two were bronchogenic cysts, two enteric and four pericardial. Embryology, morphologic presentation, clinical feature and diagnostic aspects are discussed for each group of cysts. The most modern techniques, radiological or not, available for the preoperative diagnosis are illustrated and the indication to surgical treatment of these benign mediastinal lesions is discussed.

Adult↗

A huge posteromedial mediastinal cyst complicated with vertebral dislodgment.

BACKGROUND: Mediastinal cysts compromise almost 20% of all mediastinal masses with bronchogenic subtype accounting for 60% of all cystic lesions. Although compression of adjoining soft tissues is usual, spinal complications and neurological symptoms are outmost rare and tend to characterize almost exclusively the neuroenteric cysts. CASE PRESENTATION: A young patient with intermittent, dull pain in his back and free medical history presented in the orthopaedic department of our hospital. There, the initial clinical and radiologic evaluation revealed a mediastinal mass and the patient was referred to the thoracic surgery department for further exploration. The following computed tomography (CT) and magnetic resonance imaging (MRI) shown a huge mediastinal cyst compressing the T4-T6 vertebral bodies. The neurological symptoms of the patient were attributed to this specific pathology due to the complete agreement between the location of the cyst and the nervous rule area of the compressed thoracic vertebrae. Despite our strongly suggestions for surgery the patient denied any treatment. CONCLUSION: In controversy with the common faith that the spine plays the role of the natural barrier to the further expansion of cystic lesions, our case clearly indicates that, exceptionally, mediastinal cysts may cause severe vertebral complications. Therefore, early excision should be considered especially in young patients or where close follow up is uncertain.

Journal Article↗

Management of a large mediastinal cyst of thyroid origin.

Large mediastinal cysts of the thyroid are rare and it is difficult to make a definitive tissue diagnosis prior to surgical removal. Ultrasonography and computed axial tomography are useful in documenting the cystic nature of the lesion and demonstrating its relationship to other mediastinal structures. These studies may also suggest the tissue of origin. We report a case of massive mediastinal thyroid cyst situated in the right posterior mediastinum and causing significant tracheal compression. Because of this unusual location and lack of iodine uptake, preoperative diagnosis was not possible. At surgery, which we performed via right thoracotomy because of the location of the mass, its origin from thyroid tissue was demonstrated. Resection was accomplished with care taken not to injure the recurrent laryngeal nerve. The patient recovered uneventfully.

Diagnostic Imaging↗

Ethanol sclerosis of a mediastinal cyst.

The authors report a mediastinal cyst treated by aspiration and ethanol sclerosis, which were performed under ultrasonographic guidance. Mediastinoscopy and thoracotomy were thus avoided. One year later there had been no recurrence of the cyst or any symptoms.

Ethanol↗

High prevalence of estrogen and progesterone receptor expression in mediastinal cysts situated in the posterior mediastinum.

BACKGROUND: To identify and estimate the prevalence of mediastinal cysts lined by the epithelium expressing steroid receptors. METHODS: We retrieved 19 mediastinal cysts from our pathology files from 1996 to 2004, and examined estrogen receptor (ER) and progesterone receptor (PR) expressions in the cysts. RESULTS: Three paravertebral cysts, all in women, one bronchogenic cyst in a woman, nine thymic cysts, and six pericardial cysts were found in the pathology files. Paravertebral cysts were situated in the posterior mediastinum and were attached either to the left or the right of the vertebral column. All cysts were radiologically diagnosed before surgery as neurogenic tumors. They were excised by video-assisted thoracoscopic surgery. The epithelial lining of the cyst in all three cases was strongly positive for both ER and PR. A thymic cyst in one woman was weakly positive only for the ER. In all other cases, the lining was entirely negative for both ER and PR. CONCLUSIONS: Posterior mediastinal paravertebral cysts characteristically express ER and PR. They should be recognized as a distinct type of mediastinal cyst because they are biologically different from bronchogenic cysts, seem not to be infrequent, and sometimes are misdiagnosed as a neurogenic tumor.

Adult↗

Cranial mediastinal cysts in nine cats.

Nine cats, from 11 to 17 years of age (mean 13.6 years of age), were diagnosed with a cranial mediastinal cyst. Thoracic radiographs in all cats were characterized by an increased soft tissue opacity in the cranial mediastinum confirmed to be a cyst by ultrasonography or necropsy. Ultrasonographically cysts appeared as an anechoic mass. A low-cellularity clear fluid was obtained on aspiration. The majority of the cats (n = 8) presented for unrelated conditions with no signs of respiratory distress. No treatment for the cyst was pursued except for drainage during ultrasonographic-guided aspiration in several cats. On follow-up of eight cats, none were symptomatic for the cyst from 3-45 months after diagnosis. Mediastinal cyst should be considered when a cranial mediastinal mass is evident radiographically in an older cat. The majority of feline cranial mediastinal cysts are benign with no need for treatment.

Animals↗

Acutely symptomatic benign mediastinal cysts.

Usually, cystic mediastinal masses are considered as benign. However, the size of the cyst is of importance, chiefly in a closed space such as the superior mediastinum. Rarely a dramatic symptomatology may develop though this was the case in the two patients we describe, who were admitted in the department. In the first case (a parathyroid cyst), the symptoms were due to a thrombosis of the left innominate vein, and in the second case (a thyroid cyst), the severity was dominated by a dramatic compression of the trachea and the vessels. The contribution of computed tomography is nowadays undisputed. It enables the diagnosis of the cystic nature before surgery. The diagnosis can easily be confirmed by percutaneous drainage.

Acute Disease↗