Asymptomatic Cysts Research Articles

Incidental detection of asymptomatic intrapericardial calcified hydatid cyst

Incidental detection of asymptomatic intrapericardial calcified hydatid cyst

Endoscopic Surgery for Hemorrhagic Pineal Cyst Following Antiplatelet Therapy: Case Report

Pineal cysts of the third ventricle presenting with acute obstructive hydrocephalus due to internal cystic hemorrhage are a rare clinical entity. The authors report a case of a 61-year-old man taking antiplatelet medication who suffered from a hemorrhagic pineal cyst and was treated with endoscopic surgery. One month prior to treatment, the patient was diagnosed with a brainstem infarction and received clopidogrel in addition to aspirin. A small incidental pineal cyst was concurrently diagnosed using magnetic resonance (MR) imaging which was intended to be followed conservatively. The patient presented with a sudden onset of headache and diplopia. On admission, the neurological examination revealed clouding of consciousness and Parinaud syndrome. Computerized tomography (CT) scans demonstrated a hemorrhagic mass lesion in the posterior third ventricle. The patient underwent emergency external ventricular drainage with staged endoscopic biopsy and third ventriculostomy using a flexible videoscope. Histological examination revealed pineal tissue with necrotic change and no evidence of tumor cells. One year later MR imaging demonstrated no evidence of cystic lesion and a flow void between third ventricle and prepontine cistern. In patients with asymptomatic pineal cysts who are treated with antiplatelet therapy, it is important to be aware of the risk of pineal apoplexy. Endoscopic management can be effective for treatment of hemorrhagic pineal cyst with obstructive hydrocephalus.

Steatocystoma Multiplex -A Rare Genetic Disorder:A Case Report and Review of Literature

A 17 years old female presented with multiple asymptomatic cutaneous cysts all over body, sparing the head and neck region. The microscopic examination of the cysts showed the features of steatocystoma multiplex. This disorder, although it is asymptomatic, is a cosmetic threat to the patient. Only a few cases of the patients with an autosomal dominant mutation, who had keratin 17, have been reported. We are reporting here, a case of steatocystoma multiplex in a 17 years old female, along with its review of literature.

A pelvic mass with obstructive uropathy in a 4-year old boy

Cystic Echinococcosis is endemic in middle- East it may present in different sites mostly liver, but children show atypical signs in uncommon sites. A 4 years old boy presents with urinary retention, his imaging demonstrates a 6cm cystic mass displaced and compressed bladder outlet during survey another asymptomatic cyst found in chest but his liver was not involved. Retroperitoneal Cystic Echinococcosis is a rare event especially in children if present with urinary obstruction it may be due to rectum penetration and dislodged to lymphatic drainage head to chest. Cyst growth rapidity rate is 2-3 cm/year as our study.

The Auto-Amputated Adnexa: A Review of Findings in a Pediatric Population

Study ObjectiveTo quantify our experience and that of the literature with diagnosis and management of the auto-amputated adnexa in a pediatric population. DesignCase series and literature review. SettingTertiary care medical center. ParticipantsCase series of pediatric patients (<18 years of age) with surgically documented adnexal auto-amputation collected from our medical center and the literature. InterventionsNone. Main Outcome MeasureAuto-amputated adnexa. ResultsIn addition to the 3 cases discussed from our institution, 91 cases of auto-amputated adnexa were identified in the literature dating back to 1943, for a total of 94 cases. Forty-nine percent (46/94) of the cases involved girls in a pediatric population (<18 years of age). Of these, the majority (n = 26) were identified in a subgroup of girls who were diagnosed with an adnexal cyst by antenatal ultrasound. Most of these neonates were asymptomatic at birth or had a palpable abdominal mass (n = 6) and at the time of surgical exploration were found to have an auto-amputated adnexa. 34 out of 46 cases were analyzed in detail. The right adnexa were involved in 56% of the cases. The most common presenting complaint verbalized by the older girls was pain; however, 8 cases were identified in asymptomatic girls undergoing unrelated diagnostic testing. ConclusionThe auto-amputated adnexa is a rare finding in the pediatric population, but it must be considered as a possible explanation for the incidental finding of absence of the fallopian tube or ovary in the subgroup of patients who undergo surgery for any reason. Patients with an antecedent history of pelvic pain either chronic or intermittent in nature may be diagnosed with torsion or less frequently auto-amputation of the adnexa. A fetal “pelvic mass” or “ovarian cyst” may predispose the adnexa to torsion and subsequent auto-amputation either in-utero or post-delivery. Many of these antenatally diagnosed cysts and even subsequent auto-amputations are completely asymptomatic, however, and do not compromise fertility assuming the contralateral adnexa are normal. Thus expectant management is appropriate for small (less than 4 cm), asymptomatic simple cysts and even suspected auto-amputated adnexa in an asymptomatic patient.

Liver Transplantation From a Donor With Asymptomatic Type IV-A Choledochal Cyst

Liver Transplantation From a Donor With Asymptomatic Type IV-A Choledochal Cyst

Asymptomatic blood cyst of the papillary muscle in an adult undergoing coronary bypass surgery

Blood-filled cysts of larger size attached to the heart valves represent a very rare finding in adults. We report here a case of a blood-filled cyst attached to the papillary muscle, demonstrating the importance of multimodal preoperative diagnostic imaging combining both echocardiography and magnetic resonance imaging.

Epidermoid Cyst of the Spleen

BackgroundThe aim of this study is to elucidate the characteristics, clinical presentations, and management of epidermoid cysts located in the spleen and the intrapancreatic accessory spleen. MethodsData pooled for analysis were collected from epidermoid cyst cases encountered in the study institution and sporadic case reports obtained from the English literature. ResultsThere were 115 cases of epidermoid cyst. Seventy eight (67.8 %) were found in the spleen, whereas 37 (32.2 %) were found in the intrapancreatic accessory spleen. Comparing between the two groups, the splenic group showed female predominance, younger age, and larger cystic size. For symptoms, left upper abdominal mass (57.7 %) and left upper abdominal pain (39.0 %) were more commonly found in the spleen group. Meanwhile, the intrapancreatic accessory spleen group had higher percentage of asymptomatic cysts (59.5 %). As for surgical indication, majority of patients in the spleen group underwent surgery for symptomatic relief (75.4 %), while the intrapancreatic accessory spleen group underwent surgery mainly for suspicious malignancy (90.0 %). ConclusionsSurgical treatment for epidermoid cysts of the spleen is considered the optimal treatment for either alleviating the symptoms caused by a bulky cyst or for determining the histopathologic nature of a suspicious malignant cystic neoplasm.

One-year Results of Single-session Sclerotherapy with Bleomycin in Simple Renal Cysts

PurposeTo evaluate the efficacy and safety of single-session percutaneous needle aspiration and single-injection bleomycin sclerotherapy for the treatment of simple renal cysts. Materials and MethodsA total of 66 renal cysts in 53 patients were treated by single-session percutaneous needle aspiration and single-injection bleomycin sclerotherapy under computed tomography (CT) guidance. Symptomatic (n = 31) and asymptomatic cysts (n = 22) with maximum diameters greater than 5 cm were treated. As much liquid content of each cyst was aspirated as possible, and bleomycin was injected and remained in the cyst. Follow-up was performed with ultrasonography or CT every 3 months until 1 year, and cyst volume was calculated before and after sclerotherapy. Therapeutic response was assessed by cyst volume reduction rate (VRR) and classified as complete regression (CR; ie, invisible), near-CR (ie, VRR>85%), partial regression (PR; ie, VRR of 50%–85%), or no response (NR; ie, VRR<50%). Medical records were reviewed to analyze complications. ResultsCysts refilled partially in the initial stage after sclerotherapy and decreased gradually in size over the entire follow-up period. At 1-year follow-up, the overall response rate was 98.5% (65 of 66), with CR in 31 cysts (47.0%), near-CR in 24 cysts (36.4%), PR in 10 cysts (15.1%), and NR in one cyst (1.5%). No major complications were encountered. ConclusionsSingle-session percutaneous needle aspiration and single-injection bleomycin sclerotherapy is a simple, safe, effective, well tolerated alternative technique for management of simple renal cysts.

Invited Commentary

Fievet and colleagues [1Fievet L. D'Journo X.B. Guys J.M. Thomas P.A. De Lagausie P. Bronchogenic cyst: best time for surgery?.Ann Thorac Surg. 2012; 94: 1695-1700Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar] have made a strong point favoring early surgical treatment of bronchogenic cysts despite two apparent weaknesses, such as the comparison between two dissimilar populations (ie, adult and pediatric) and the aggressive approach to the bronchogenic cysts regardless of the presence of symptoms. In fact, surgery for bronchogenic cysts is usually recommended for lesions increasing in size or complicated by infection, whereas small, asymptomatic cysts should be observed. The rigorous analysis of the authors' experience resulting from the contribution of pediatric and general thoracic surgeons has indeed supported their practice of offering an operation within the first year of life (mean age at operation, 11 months) when the diagnosis is suspected before birth, and within the third year after postnatal diagnosis. Unfortunately, a thorough description of the anesthetic techniques and the thoracoscopic instrumentation routinely used in pediatric patients is missing. However, the forte of this experience is represented by the notion of managing bronchogenic cysts as a continuum from the prenatal phase to infancy and adulthood by contemplating two different surgical approaches (thoracoscopy and thoracotomy). From the integration of pediatric and adult thoracic surgical knowledge, it is clear that early surgery for bronchogenic cysts avoids the superimposed inflammatory changes with the attendant fibrosis, which ultimately complicate resection in the adult. In this age group, a thoracoscopic approach is less likely to be successful and some degree of lung resection becomes necessary. Accordingly, whenever feasible, video-assisted thoracic surgical resection of early detected cysts may represent a “conservative” radical approach—both an intriguing and ambitious concept. Fievet and colleagues should be commended on focusing on a preventative diagnostic and therapeutic pathway for a congenital condition that is frequently managed as an orphan disease. Larger series are needed to confirm a possible effect of this strategy on the clinical practice. Nevertheless, this manuscript clearly reiterates that the combination of general thoracic and pediatric surgical expertise is certainly an asset in institutions dedicated to the management of the wide range of thoracic conditions. Bronchogenic Cyst: Best Time for Surgery?The Annals of Thoracic SurgeryVol. 94Issue 5PreviewBronchogenic cyst (BC) is a benign congenital mediastinal tumor whose natural course remains unclear. In adults, most BCs are removed by thoracotomy after complications. Currently, prenatal diagnosis is generally feasible and allows an early thoracoscopic intervention. The purpose of this retrospective study was to ascertain the best time for the operation. Full-Text PDF

Mediastinal bronchogenic cyst presenting with pericardial effusion

We report a case of a 58-year-old woman who had a bronchogenic cyst presenting with pericardial effusion. Initially, the effusion had disappeared prior to resection of the cyst, but it reappeared with additional symptoms. Resection of the bronchogenic cyst resulted in complete resolution of the pericardial effusion and additional symptoms such as progressive dyspnea and chest pain. Application of surgical treatment for asymptomatic cysts in adults remains controversial, but we recommend that mediastinal cysts which present with any symptoms should be resected at the time of their discovery, even though the symptoms disappeared for a while.

Laparoscopic treatment of urachal remnants

ObjectivesThe urachus is a vestigial obliterated structure derived from the alantois. Failure of this involution process originates patent urachal remnants. Surgery is the treatment of choice as it prevents both recurrence of symptoms and malignant transformation. The purpose of this study is to present our experience in the laparoscopic management of this pathology. Material and methodsThree male patients (mean age 39 years) underwent laparoscopic excision of urachal remnants. Two patients were diagnosed with an asymptomatic cyst and one patient with urachal sinus presenting with umbilical discharge. A three-port technique was used to remove the whole urachus tract from the umbilicus to the bladder dome, together with a small bladder patch. ResultsMean operating time was 94min and blood loss was minimal. One patient had small intra-operative bladder rupture, successfully managed with adequate closure. No post-operative complications were observed and all patients were discharged on the second postoperative day. Two years later there was no evidence of recurrence. ConclusionsUrachal remnants can be successfully treated by laparoscopic surgery, with advantages in terms of morbidity, recovery and cosmetic outcome. Large number, comparative studies are still needed to definitely establish it as the gold standard treatment.

Surgical management of cystic lesions in the liver

Liver cysts are common, occurring in up to 5% of the population. For many types of cysts, a variety of different treatment options exist and the preferred management is unclear. A Pubmed and Medline literature review using key words non-parasitic hepatic cysts, polycystic liver disease, echinococcus, hydatid cysts parasitic cysts, Caroli's disease, cystadenoma; liver abscess, surgery, aspiration and treatment was undertaken and papers pertaining to the diagnosis and management of cystic lesions within the liver were retrieved. Asymptomatic simple cysts in the liver require no treatment. Therapy for symptomatic cysts may incorporate aspiration with sclerotherapy or de-roofing. At present, insufficient evidence exists to recommend one over the other. Polycystic liver disease presents a unique management problem because of high morbidity and mortality rates from intervention and high rates of recurrence. Careful patient counselling and assessment of symptom index is essential before embarking on any treatment. New medical treatments may ameliorate symptoms. Acquired cystic lesions in the liver require a thorough work-up to fully characterize the abnormality and direct appropriate treatment. Hydatid cysts are best treated by chemotherapy followed by some form of surgical intervention (either aspiration and sclerotherapy or surgery). Liver abscesses can effectively be treated by aspiration or drainage. With improved antimicrobial efficacy, prolonged treatment with antibiotics may also be considered. All patients with cystic lesions in the liver require discussion at multi-disciplinary meetings to confirm and the diagnosis and determine the most appropriate method of treatment.

1,450-nm Diode Laser in Combination with the 1550-nm Fractionated Erbium-Doped Fiber Laser for the Treatment of Steatocystoma Multiplex: A Case Report

Steatocystoma multiplex (SM) is a rare condition characterized by multiple, small, asymptomatic dermal cysts. Treatment options are limited, with varying degrees of success; these include oral isotretinoin, surgical excision or drainage, and liquid nitrogen cryotherapy. The most effective method is excision, but cosmetic considerations, time, overall cost, and pain must be considered, because patients tend to have multiple cysts. Lasers, especially nonablative devices, have not frequently been used to treat SM. Herein, we present the case of a patient with isolated steatocystoma multiplex on the abdomen and lower chest with substantial clearance after two laser treatment sessions using two complementary lasers: a 1,450-nm diode laser to target the abnormal sebaceous glands and a 1,550-nm fractionated erbium-doped fiber laser to target the dermal cysts.

Asymptomatic Thymic Cyst Appearing in the Neck on Valsalva: Unusual Presentation of a Rare Disease

Thymic cysts are usually diagnosed accidentally during radiological evaluation of the chest for unrelated conditions. Symptoms appear late when the mass compresses on adjoining tissues. We report an unusual case of asymptomatic mediastinal thymic cyst which was seen in the neck whenever the patient was asked to perform Valsalva maneuver. This case is being reported for the unusual clinical presentation of a rare disease. The role of imaging in the diagnosis and common differential diagnoses are also discussed.

A rare presentation of colonic duplication cyst: report of a case and review of the literature.

Duplication cyst is an uncommon congenital abnormality of the alimentary tract. It can occur anywhere in the alimentary tract with the ileum and the jejunum representing the most common sites of duplication. Most often the patients are asymptomatic and colonic duplication cysts remain undiagnosed for years. In this case report we present an unusual case of colonic duplication cyst with a transverse colon location. We present the radiological findings of this rare congenital malformation in order to be included in the differential diagnosis of cystic masses of the gastrointestinal tract.

A Persistant ‘Can't Intubate, Can't Oxygenate’ Crisis despite Rocuronium Reversal with Sugammadex

A 'can't intubate, can't oxygenate' airway crisis is a rare event which most anaesthetists will never experience during their career(1,2). This report highlights the outcome of time-critical decisions in a potential airway catastrophe. Rocuronium was used as an alternative muscle relaxant for rapid sequence induction. The use of sugammadex in 'can't intubate, can't oxygenate' crises is discussed and highlights how, despite adequate reversal of neuromuscular blockade, the 'can't intubate, can't oxygenate' situation failed to resolve. An asymptomatic vallecular cyst was the causal factor in this scenario. Anaesthetic issues surrounding this pathology are discussed.

Timing of surgery for prenatally diagnosed asymptomatic choledochal cysts: a prospective randomized study

Background/PurposeCholedochal cysts (CDCs) are increasingly being diagnosed antenatally. The timing of surgery in this group of patients is unclear. We undertook a prospective randomized trial to establish the optimal timing of surgery for prenatally diagnosed asymptomatic CDCs. MethodsBetween 2003 and 2011, 68 fetuses with ultrasound-detected subhepatic cysts (ie, potential CDC) were randomized into 2 groups: (1) early (≤1 month) operation group (n = 34) and (2) late (>1 month) operation group (LO; n = 34). Operative time, postoperative hospital stay, drainage duration, postoperative complications, and perioperative ultrasonographic and laboratory results were analyzed. ResultsDuring the first month of life, 32 infants became symptomatic (eg, became jaundiced) and were excluded from the trial. This left 36 neonates who were asymptomatic (early operation, n = 16; LO, n = 20) and constituted the study group. It is noteworthy that a further 9 infants in the LO group then became symptomatic after 1 month of age. Grades III and IV hepatic fibroses were significantly more common in the LO group and in patients who were diagnosed during early pregnancy. Interestingly, liver functions in patients diagnosed at early fetal stage were only moderately deranged. Median follow-up period was 36 months. Neither mortality nor complications of bile leak or anastomotic stricture were encountered. However, complete liver function normalization was significantly delayed in the LO group and in patients with high-grade hepatic fibrosis. ConclusionPrenatally diagnosed CDC is a distinct group with a tendency of developing liver fibrosis immediately after birth. Early surgical intervention is warranted in the neonatal period.

Asymptomatic Multiple Splenic Cysts in a Pulmonary Neoplasm Patient

Splenic cysts are rare, and their treatment remains challenging. A 66-year-old man scheduled to undergo surgical treatment for a pulmonary neoplasm was found with abdominal computed tomography and ultrasonography to have multiple cysts in the body of the spleen. He underwent pulmonary wedge resection, and histological examination showed that the lesion of the left lung was an adenocarcinoma. The patient recovered without complications after the operation. Because the splenic cysts were small and caused no abdominal symptoms, the patient was advised to undergo careful follow-up. Large splenic cysts warrant surgical treatment, whereas careful follow-up is recommended for small asymptomatic splenic cysts.

Partially Reversible Hypopituitarism in an Adolescent with a Rathke Cleft Cyst

Rathke cleft cysts are remnants of the Rathke pouch. Most of them are asymptomatic, but sometimes they can grow enough to cause compression of structures within and/or close to the sella, thus eliciting symptoms such as visual disturbance, pituitary defects, and headache. Asymptomatic cysts can safely be followed up with serial imaging, while the standard treatment for symptomatic lesions is surgical removal. We describe a 14-yr-old boy, admitted for anorexia, fatigue, weight loss, recurrent headache and vomiting. Magnetic resonance imaging showed an intra- and suprasellar cystic lesion, which was surgically removed. Histology was consistent with Rathke’s cleft cyst. Diabetes insipidus and multiple anterior pituitary defects (GH, ACTH and TSH) were found preoperatively, and substitutive therapy was started. No additional hormonal defect appeared after surgery. After 4 yr of follow up, pituitary function was retested, and there were no confirmed GH or ACTH defects, allowing a partial withdrawal of replacement therapy. Our report confirms that pituitary defects, in patients with a Rathke cleft cyst, may recover even year after surgery. Thus, retesting of pituitary axes is indicated during long-term follow up.