Cases reported "Mediastinal Cyst"

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1/6. Thymic cyst: is a correct preoperative diagnosis possible? Report of a case and review of the literature.

    A case of a giant cervico-mediastinal cyst of thymic origin in an 8-year-old child is presented. The cyst was asymptomatic except for deformity due to its size. In spite of several diagnostic approaches like ultrasonography, computed tomography, cyst puncture with biochemical analysis of cyst content and direct contrast injection and radiography after emptying of the cyst, the ultimate diagnosis as to the origin of the cyst was not disclosed until after operation and histopathological examination of the operative specimen. On a more general basis the diagnostic possibilities and pitfalls are discussed. Conclusion: a correct preoperative diagnosis of a thymus cyst is difficult and in many instances impossible even when all diagnostic measures at hand are utilized, including radiographic methods, computed tomography, magnetic resonance imaging, ultrasonography and biochemical examination of cyst aspirate and estimation of tumour markers in cyst fluid and serum.
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2/6. Percutaneous drainage of mediastinal pseudocysts.

    Percutaneous catheter drainage of a mediastinal pseudocyst was performed in two patients. Access was gained through computed tomography (CT)-guided puncture of the abdominal portion of the pseudocyst in one patient, and a transhepatic-subxiphoid approach was used in the other. Guide wires and catheters were advanced into the mediastinal pseudocysts under CT control. drainage was technically successful in both patients, with no procedure-related complications. Percutaneous drainage is an alternative to the surgical treatment of symptomatic and nonresolving mediastinal pseudocysts, provided that a safe access route can be found.
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3/6. Transformation of a pericardial cyst observed on long-term follow-up.

    An atypical pattern of pericardial cyst was observed on a routine chest radiograph of a healthy 25-year-old woman. It appeared as an important elevation of the right diaphragm. The cystic nature of the mass was easily disclosed by ultrasonography and computed tomography, but its location--thoracic, diaphragmatic, or subphrenic--remained questionable. Finally, a percutaneous puncture yielded 1300 mL of clear liquid. Despite this huge volume, the cyst had been asymptomatic and did not recur after complete aspiration. Retrospectively, owing to previous files, we could recognize the evolution of a pericardial cyst from the age of 13 years. At that time, it was much smaller and was evaluated by a series of aggressive investigations, although it had a more typical pattern and was confined to the right cardiophrenic angle.
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4/6. Calcified pleuropericardic cysts--2 cases report.

    Pleuropericardic cysts represent 5 to 7 per cent of tumours of the mediastinum. Their origin is a defect in development of pericardic coelomic cavities. They are located in the right and cardio-phrenic corner in 70 per cent of cases. They are generally asymptomatic. They are best treated by a thin needle puncture under scanography. Surgery is needed only when the cyst wall is thick. We have treated surgically 2 cases of large cysts, because of their sizes (10 cm and 13 cm of diametres respectively), and, mostly, because of their calcification. Symptomatology was dominated by respiratory signs, such as dyspnea. In one case, there were manifestations of inferior vena cava compression. diagnosis was done by roentgenography of the thorax. The surgical procedure, using right thoracotomy, revealed a calcified cyst in both cases, with a tough wall, which was resected. In one case, the removal of adhesion to the inferior vena cava injured this vessel which was sutured after partial clamping. hemorrhage was severe and 2.51 blood transfusion was necessary. The post operative course was uneventful. Clinical signs of compression disappeared in both cases.
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5/6. Pleuropericardial cysts: treatment by videothoracoscopy.

    Four cases of pleuropericardial cyst (three symptomatic, one in an unusual location) were treated by videothoracoscopy. Complete resection of the cyst was possible in all cases. The postoperative course was uneventful and patients were discharged on the 4th or 5th day. Pleuropericardial cysts account for 5 to 10% of all mediastinal tumors. Clinical latency and a benign course are characteristic features. In most cases, computed tomography (CT) confirms the diagnosis. When the cyst is symptomatic or the diagnosis is in doubt (atypical location, high density on CT scans), videothoracoscopy offers an alternative to transpleural puncture with evacuation or excision via thoracotomy.
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6/6. thoracic duct cyst in supraclavicular region.

    A 28-year-old female attended an outpatient clinic in October, 1989, because of a tumor in the left supraclavicular fossa, detected in a health examination. Following exploratory puncture of the tumor which yielded milky-white fluid, suggesting a cyst in the thoracic duct, she was admitted to our department. The cyst was unilocular measuring about 6 cm in diameter, and the fluid content was chyle-rich in lipids. lymphography demonstrated a lymphatic structure adjacent to the lesion and scattered lymph vessels on the cyst surface. On November 16 the cyst was resected. A restiform structure was observed between the cyst and the thoracic duct, but the presence or absence of communication was unclear. The histological diagnosis was thoracic duct cyst. thoracic duct cyst occurring in the cervical region is very rare. Our case may provide useful information as to its pathogenesis and the mode of retention of cyst fluid.
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