Etiologies and management of thoracic cysts

Abstract

Introduction: Thoracic cysts have many etiologies that differ in frequency depending on the region.Their management depends on their etiologies and their complications. Aim: To review the role of different workups in identifying etiologies of thoracic cysts and to study possible therapeutic options. Methods: A retrospective study conducted between 2000 and 2015 including 44 cases of thoracic cysts. Results: Mean age was 39 years.Twenty six patients were females. The symptoms were dominated by chest pain (33 cases).Chest X Ray found round lesions (n=42) and pleural effusion (n=4).Hydatic cystic serology was positive(n=9). Bronchial fibroscopy showed hydatid membrane (n=5). The ultrasound examination and computed tomographic concluded to diagnosis (n=29) and showed associated abdominal cyst (n=9). Cysts were pulmonary (n=44) and mediastinal (n=4). In one case, they were located in chest wall. Cysts were multiple in 9 cases. Hydatidosis was diagnosed in 41 cases, thymic cyst in one case, coelomic cyst was found in one case and hamartochondrom in one case. There was 16 cysts ruptured to the bronchial system, four ruptured to the pleura, one to the pericardium. Two cases of hydatid embilism were noted. Surgically treated was performed (n=43): kystectomy (n=37), perikystectomy (n=9), atypical lung resection (n=1), lobectomy (n=4), pleural decortication (n=3), abdominal surgery (n=4) and costal resection(n=1) . Medical treatment (Albendazole) was associated in 4 cases. No case of relapse was noted. Conclusion: In Tunisia, thoracic cyst9s etiologies are dominated by hydatic pathology. Surgery represents the major therapy for cysts, simple or complicated, and the only way to reach a definite diagnosis.