Mediastinal Cystic Lesions Research Articles

Globe in the Heart: A Rare Case Report of Giant Coronary Artery Aneurysm

A 22-year-old male having cardiomegaly with prominent right atrium (RA) enlargement in his chest X-ray underwent echocardiography which revealed an anterior mediastinal cystic lesion. Contrast-enhanced computed tomography of the thorax showed saccular contrast filling outpouching from ostia of the right coronary artery (RCA) of size 5.9 × 6.4 cm in anterior atrioventricular groove compressing RA and right ventricle along the RCA course. The left main coronary artery also appeared to be dilated with a diameter of 1.1 cm proximally. The patient denied any prior angina, palpitation, and dyspnea on exertion. This case is reported for its rarity and the dilemma involving its appropriate medical and surgical management.

Imaging modalities (MRI, CT, PET/CT), indications, differential diagnosis and imaging characteristics of cystic mediastinal masses: a review.

Cystic mediastinal masses have traditionally represented a diagnostic dilemma with differentiation of malignant masses a particular area of concern. Each imaging modality has strengths and weaknesses in mediastinal imaging-computed tomography (CT) offers increased spatial resolution at the cost of poorer soft tissue differentiation and requiring ionizing radiation, while magnetic resonance imaging (MRI) offers superior soft tissue contrast/characterization at significantly greater cost. Ultrasound offers real-time visualization but is operator and tissue dependent. [18F]fluoro-D-glucose (F-18 FDG) positron emission tomography (F-18 FDG PET) CT provides functional information, but poorer spatial resolution. Recent advances have focused upon the use of magnetic resonance imaging to aid in characterization of cystic mediastinal lesions, particularly in the context of indeterminate CT findings. The mediastinum may be divided into three anatomic compartments: prevascular, visceral, and paravertebral. All three compartments extend superiorly from the thoracic inlet and inferiorly to the diaphragm. These compartments provide a useful framework for categorizing normal and pathologic mediastinal processes. In this article, we will review the imaging characteristics of mediastinal cystic lesions via a case-based review divided by anatomical mediastinal compartments. Characteristic imaging features and troubleshooting are particular areas of focus. Normal variants that may mimic cystic pathology are discussed. The roles of CT and MRI will be emphasized. Cases from our institution are presented as illustrative examples.

Giant cervicomediastinal non-functioning parathyroid cyst: A rare case

Parathyroid cysts of cervicomediastinal location are rare with only a few cases reported in the international literature. We present a rare case of parathyroid cyst in a 57 years old female with gradually increasing neck swelling and dysphagia. Examination revealed about 5 cm anterior neck swelling which moves with swallowing. Blood results including tumor markers and calcium levels were all unremarkable. Chest radiography noted visible mass with cervicothoracic sign and right tracheal deviation. A computed tomography showed a large anterior mediastinal cystic mass with left supraclavicular extension, size 5 x10 x 14cm pushing trachea to the right side from thyroid cartilage till carina level. She successfully underwent left subtotal thyroidectomy (for coexisting thyroid nodules) and median sternotomy and cyst excision. Operative histopathological examination revealed a parathyroid cyst. The patient’s symptoms were relieved after surgery. Parathyroid cyst can therefore present as a rare cause of neck and mediastinal cystic lesion.

MRI-Based Stepwise Approach to Anterior Mediastinal Cystic Lesions for Diagnosis and Further Management

As the majority of incidentally detected lesions in the anterior mediastinum is small nodules with soft tissue appearance, the differential diagnosis has typically included thymic neoplasm and prevascular lymph node, with benign cyst. Overestimation or misinterpretation of these lesions can lead to unnecessary surgery for ultimately benign conditions. nonsurgical anterior mediastinal lesions. The pitfalls of MRI evaluation for anterior mediastinal cystic lesions are as follows: first, we acknowledge the limitation of T2-weighted images for evaluating benign cystic lesions. Due to variable contents within benign cystic lesions, such as hemorrhage, T2 signal intensity may be variable. Second, owing to extensive necrosis and cystic changes, the T2 shine-through effect may be seen on diffusion-weighted images (DWI), and small solid portions might be missed on enhanced images. Therefore, both enhancement and DWI with apparent diffusion coefficient values should be considered. An algorithm will be suggested for the diagnostic evaluation of anterior mediastinal cystic lesions, and finally, a management strategy based on MRI features will be suggested.

Cysts and cyst-like formations of the mediastum: clinical and radiological manifestations

. Mediastinal cystic formations are well-shaped, often round formations that contain fluid and are lined with epithelium. The main cystic formations include congenital benign cysts (bronchogenic, duplicating the esophagus, neuroenteric, pericardial and thymic cysts), meningocele, mature cystic teratomas and lymphangiomas. Many tumors (e.g., thymomas, Hodgkin's disease, germ cell tumors, mediastinal carcinomas, lymph node metastases, nerve root tumors) may undergo cystic degeneration, especially after radiation or chemotherapy, and show mixed solid and cystic elements on computed tomography (CT) or magnetic resonance imaging (MRI), as well as acquire the structure of cavity formations during the tumor destruction. If the degeneration is extensive, such tumors may be virtually indistinguishable from con­genital cysts. However, the history of the disease, visualization of the anatomical location of the formation, some details visible on CT or MRI, allow in many cases to make the correct diagnosis. Familiarity with the radiographic features of mediastinal cystic lesions facilitates accurate diagnosis, differentiation from other cystic lesions, and thus ensures optimal treatment of a patienta.

APPORT DE LIMAGERIE DANS LES LESIONS KYSTIQUES MEDIASTINALES CONTRIBUTION OF IMAGING IN CYSTIC MEDIASTINAL LESIONS

Retrospective study of 26 radioclinical cases of mediastinal cystic lesions, realized betweenJanuary 2011 and December 2015 in the radiology department of the UHC Hassan II of Fez.All patients were examined by a chest X-ray (face and profile), a CT scan, and an ultrasoundinafew cases. The patients of our series were distributed as follows: Tumor and malformative origin (cysticlymphangioma in 6 cases, thymic cyst in 4 cases, bronchogenic cyst in 3 cases and pleuro-pericardialcystin2cases),infectiousorigin(hydatidcystin5cases,mediastinalabscessin4cases,Tuberculosisin2cases).Theimageryallowedtoeasilyconfirmtheliquidnatureof thesemasses.Theetiologiesareveryvariedandthediagnosticorientationisbasedessentially onthe topography andtheage ofthe patient.

Unilocular thymic cyst with features of intra-thymic bronchogenic cyst: A clinicopathological correlation of 4 cases.

Four cases of primary unilocular thymic with features of bronchogenic cyst are presented. The patients are three men and a woman between the ages of 43 and 57 years. All the patients presented with symptoms of cough, chest pain, and dyspnea. Diagnostic imaging revealed the presence of an anterior mediastinal cystic lesion. Initial mediastinoscopic biopsies were non-diagnostic. Surgical resection of the anterior mediastinal cystic lesion was performed in all patients. Macroscopically, all the lesions were described as large cystic lesions measuring from 2 to 4cm in largest diameter and containing yellowish fluid. The surface of the cysts was described as corrugated and of brownish color. The walls of the cysts were not thickened and no other elements were described. Histologically, the cystic lesions were characterized by single cystic structures lined by ciliated epithelium. No atypia or mitotic activity was present in any of the cases. Immunohistochemical stains show positive staining of the respiratory epithelium with keratin and negative staining for GATA3, PAX-8, TTF-1, and Napsin. All the patients have recovered well after surgical resection.

Characteristics and outcomes of anterior mediastinal cystic lesions diagnosed on chest MRI: implications for management of cystic lesions

BackgroundChest MRI is a useful diagnostic modality for the evaluation of anterior mediastinal lesions but the outcomes of anterior mediastinal cystic lesions diagnosed on chest MRI are unclear.MethodsIn this multicenter retrospective study, patients who underwent contrast-enhanced chest MRI in two tertiary centers to assess anterior mediastinal cystic lesions were included after excluding overt solid tumors and thymic hyperplasia. Anterior mediastinal cystic lesions were classified into two categories: probable (simple) cyst or indeterminate lesion (complex cyst). Size and imaging features of lesions during follow-up were evaluated and clinical outcomes were assessed.ResultsA total of 204 patients (mean age, 59 ± 11 years; M:F = 111:93) were studied; 186 (91.2%) were classified as probable cysts and 18 (8.8%) as indeterminate lesions on MRI. Among patients with probable cysts and more than 2 years of follow-up, lesion size was unchanged in 39.6% (36/91), decreased in 16.5% (15/91), and fluctuated in 8.8% (8/91). All patients who underwent surgery were confirmed cysts. None developed mural nodules or irregular wall thickening, suspicious for malignancy during follow-up. In patients with indeterminate lesions, 16.7% (3/18) had pathologically confirmed thymoma and 44.4% (8/18) had proven cysts. Follow-up numbers and intervals after MRI in patients with probable cysts were variable among physicians and institutions in clinical practice (p < 0.05) but more than half were followed for up to 2 years in two centers.ConclusionDiagnosing anterior mediastinal cysts using MRI is reliable. MRI-based management of anterior mediastinal lesions may reduce the number of unnecessary follow-ups and surgeries.

Large non-functioning substernal parathyroid cyst: A case report and review of the literature.

ObjectivesParathyroid cysts are rare benign lesions of the head and neck that account for less than 1% of cystic neck masses. We present a rare case of a large 6 cm substernal parathyroid cyst.Presentation of caseAn otherwise healthy 65 year-old female presented to the otolaryngology clinic for evaluation of an anterior, midline neck mass. On physical exam, she was noted to have a fullness in the anterior neck extending to the sternal notch. CT demonstrated an enlarged thyroid with a cyst extending to the aortic arch. Initial evaluation suggested a bilateral goiter with substernal extension. The cyst was managed with drainage and observation. After two years of continued growth, the patient underwent a left thyroid lobectomy and mediastinal mass resection via the cervical approach. Final pathology was consistent with a parathyroid cyst.ConclusionsParathyroid cysts are a rare cause of neck mass in an adult, and a 6 cm substernal parathyroid cyst represents an unusual site and size for these cysts. Parathyroid cysts are not often considered on the differential of neck and mediastinal cystic lesions. However, appropriate steps should be taken to ensure a proper diagnosis for any cystic lesion in the neck.

Thymic carcinoma and branchial cyst in a cat

AbstractA 10‐year‐old female spayed Maine Coon presented with lethargy, weight loss and severe dyspnoea. Radiographs showed mediastinal enlargement and marked pleural effusion. Thoracocentesis yielded a highly protein‐rich transudate with macrophages predominating. Computed tomography identified a large cystic mediastinal structure with a typical peripheral contrast‐enhancing rim, but fluid contents with a high attenuation of 35HU and internal contrast‐enhancing projections raising concern for neoplasia. However, mediastinal cytology failed to demonstrate neoplastic cells, but instead ciliated columnar epithelium most consistent with a thymic branchial cyst. The cat underwent median thoracotomy and mediastinal mass resection and is well 6 months postoperatively, with no evidence of recurrence. Histopathology with immunohistochemistry diagnosed thymic carcinoma, with branchial duct remnants. This report highlights the diagnostic challenge of mediastinal cystic lesions and the possible concurrent presence of a non‐neoplastic and a malignant neoplastic process.

Mediastinal thoracic duct cyst: A rare entity

Thoracic Duct Cysts (TDCs) are exceedingly rare benign masses of the posterior mediastinum. They are thought to arise from congenital or degenerative weakening in the thoracic duct wall. We bring to light an incidentally detected posterior mediastinal cystic lesion that caused dysphagia in our patient and was found to be a thoracic duct cyst.

Taponamiento cardíaco en linfoma de Hodgkin asociado a quiste mediastinal

Pericardial effusion in Hodgkin's lymphoma (HL) has a low frequency and it is mostly asymptomatic.However, cardiac tamponade as an initial presentation in this pathology is rare, and even rarer in association with a mediastinal cyst of primary thymic origin. We present the case of a 26-year-old patient who, after a recent diagnosis of classic scleronodular HL, presented to our institution with cardiac tamponade associated with a mediastinal cystic lesion of uncertain aetiology.

Paratracheal air cyst and bronchogenic cyst in patients with esophageal cancer who received thoracoscopic esophagectomy: A case series of three patients.

Introduction and importanceMediastinal cystic lesions, such as paratracheal air cyst (PTAC) and bronchogenic cyst (BC), are rare anomaly usually found incidentally in thoracic imaging. Special attention is needed in the case of thoracic surgery.Case presentationAll three patients were male, 71, 73, and 76 years old. Preoperative CT showed each had a lobular cystic lesion at the right posterolateral side of trachea in the thoracic outlet 11, 14, and 19 mm in size, respectively, with air density and tracheal communication, leading to a diagnosis of PTACs. An oval cystic lesion, 7 mm in size, was found in one patient at the right lateral side of the upper esophagus with low density and without tracheal communication, leading to a diagnosis of paraesophageal BC. Intraoperative findings of the three PTACs demonstrated a soft bulge from the membranous portion of trachea that was left intact. The BC had an oval elastic structure, mimicking a metastatic lymph node, and was removed with the mediastinal lymph nodes. Histological examination showed ciliated columnar epithelium, confirming a diagnosis of BC.Clinical discussionPTACs are associated with increased intraluminal pressure due to chronic lung disease. BCs are congenital anomalies that originate from abnormal budding of the embryonic foregut.ConclusionPTACs and BCs need to be considered in preoperative image diagnosis in patients with esophageal cancer. PTACs should be left intact to avoid tracheal injury, while removal of isolated BCs is recommended as a diagnostic and therapeutic measure.

Role of Imaging in the Diagnosis of an Enteric Duplication Cyst of the Esophagus: A Case Report

Aims: Show the importance of imaging in the diagnosis of enteric cysts of the esophagus and the main differences with other mediastinal cystic lesions. Presentation of case: We report a case of an enteric cyst of the esophagus, in a 25 year old patient, with dyspnea on exertion. X-ray shows an oval opacity in the posterior mediastinum and the CT scan and MRI show a cystic mass of the posterior mediastinum, presenting intimate contact with the esophagus, with discreet wall contrast enhancement. Discussion and Conclusion: Enteric duplication cysts are rare congenital malformations formed during the embryonic development of the digestive tract. They are usually detected prenatally or in the first years of life. Their size, location, type and presence of complications produce a varied clinical presentation and different imaging findings. They most frequently occur in the small intestine, particularly the ileum, but can occur anywhere along the gastrointestinal tract. In the case of an enteric cyst of the esophagus, the first imaging method for diagnosis is the chest x-ray because of the breathing difficulty patients can experience due to compression of the airway. Magnetic resonance (MR) and computed tomography (CT) can help the radiologist in the diagnosis and the surgeon by evaluating more precisely the mass measurements and describing its anatomical relationship with the vessels and surrounding organs. Confirmation remains histological.

Mediastinal calcified hydatid cyst

Mediastinal hydatid cyst is a rare disease and should be considered in differential diagnosis of mediastinal cystic lesions especially in endemic regions. This localization is very serious because of the surrounding vital structures. Surgery must be indicated immediately using conservative techniques without extensive resection when progression of dissection is difficult or dangerous. Medical treatment is necessary to prevent recurrence.

Evaluation of the components of mediastinal cystic lesions using imaging techniques

To identify and differentiate patients with mediastinal cysts from those with cystic tumors requiring surgery. A total of 36 patients with mediastinal cystic lesions were enrolled. The patients were separated into two groups based on pathological findings : those with mediastinal cysts (n=23) and those with mediastinal tumors (n=13). The cystic components were measured using imaging parameters including mean computed tomography (CT) value, apparent diffusion coefficient (ADC), T1 signal intensity ratio (T1SIratio), and T2 signal intensity ratio (T2SI-ratio), acquired from magnetic resonance imaging (MRI) ; and standardized maximum uptake value (SUVmax) from18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). Both groups were statistically compared. Comparative parameters between the cysts and tumors revealed the following ratios : CT value, 40.9?21.2 versus (vs) 24.8?12.9 (p = 0.019) ;SUVmax, 1.18?0.50 vs 4.32?3.52 (p = 0.003) ; ADC, 3.46?0.96 vs 2.68?0.74 (p = 0.022) ; T1SI-ratio, 1.06?0.60 vs 1.35? 0.92 (p = 0.648) ; T2SI-ratio, 5.40?1.80 vs 4.33?1.58 (p = 0.194). However, there was no correlation between FDG uptake and ADC value. SUVmax from18F-FDG PET/CT and ADC derived from MRI were effective in facilitating preoperative diagnosis to differentiate mediastinal cysts from tumors. However, these examinations may be complementary to one another, not dominant. J. Med. Invest. 66 : 106-111, February, 2019.

Application of endoscopic ultrasound-guided-fine needle aspiration combined with cyst fluid analysis for the diagnosis of mediastinal cystic lesions.

BackgroundMediastinal cystic lesions account for approximately 15–20% of all mediastinal masses and are difficult to differentiate because of similar imaging manifestation. The aim of this study was to differentiate mediastinum cystic lesions through endoscopic ultrasound‐guided‐fine needle aspiration (EUS‐FNA) and parameters from cyst‐fluid analysis.MethodsOver a period of eight years, 37 patients suspected with mediastinal cystic lesions were assessed. Cyst fluid was collected via EUS‐FNA and further examined using cytological and biochemical techniques. Definitive diagnosis was established based on cytology, surgical pathology, and/or clinical follow‐up.ResultsBased on the final pathological reports or long‐term follow‐up, 19 patients were diagnosed with benign cysts, 14 with benign or malignant tumors, 2 with tuberculosis, 1 with an abscess, and 1 with a pancreatic pseudocyst. Computed tomography or magnetic resonance imaging mistakenly distinguished eight cases as solid masses (27.03%), but EUS revealed cystic characteristics. Carcinoembryonic antigen and lactate dehydrogenase (LDH) were evaluated from the cyst fluid obtained by EUS‐FNA. There was no statistically significant difference in carcinoembryonic antigen values between benign and malignant cysts; however the average LDH value in the malignancy group was significantly higher than in the benign group.ConclusionEUS‐FNA showed great potential for differentiating mediastinal lesions by combining imaging manifestation and cytological examination. The elevated LDH value from cyst fluid chemical analysis could be used as an auxiliary indicator for diagnosing malignancy.

Mediastinal Schwannoma Masquerading as a Cystic Lesion: A Case Report and Review of the Literature

Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a safe and minimally invasive diagnostic technique for the analysis of mediastinal lesions. This approach, however, may result in life-threatening mediastinitis. Here we report a rare case of mediastinal schwannoma presenting as a cystic lesion and pose an important question of risk versus benefit of aspiration of cystic lesions. A 39-year-old man developed persistent non-productive cough and dysphasia to solids for several months. A computed tomography (CT) of the chest revealed a large posterior upper mediastinal mass measuring 6.3 x 4.5 x 8.0 cm displacing the esophagus to the right and the trachea anteriorly, with a standardized uptake value (SUV) of 2.8. The patient then had a bronchoscopy, which showed marked extrinsic compression of the mid trachea without endobronchial disease. An esophagoduodenoscopy (EGD) and EUS were performed and were notable for an 8 cm oval, well-demarcated anechoic lesion with both solid and cystic components adjacent to the esophagus. FNA was intentionally not performed due to the risk of mediastinitis. The patient had a subsequent magnetic resonance imaging (MRI) of the chest showing the 9.3 x 4.1 x 6.0 cm midline retrotracheal superior mediastinal mass. He ultimately underwent posterolateral thoracotomy with excision of the lesion. A frozen section was consistent with a neurogenic tumor. Final pathology revealed a schwannoma. Diagnosis of mediastinal masses poses a significant challenge. The differential diagnosis for a posterior mediastinal mass alone includes neurogenic tumor, neuroblastic tumor, non-neurogenic tumor, paraspinal abscess, hernia, lymphadenopathy or lymphoma, foreget duplication cysts, and thoracic meningocele. EUS-FNA is a minimally invasive and a safe procedure with a complication rate (i.e. infection, bleeding, acute pancreatitis) of approximately 1%. This rate, however, increases when the lesion contains a cystic component rather than a purely solid lesion. Several case reports have described cystic infection and mediastinitis despite accepted techniques including prophylactic antibiotics. Schwannomas generally appear as solid lesions when imaged by either CT or MRI. In 23-30% of cases, this subtype of neurofibromas may be cystic and performing a FNA may result in serious consequences. More data are needed to accurately provide the risks and benefits of EUS-FNA of mediastinal cystic lesions and to validate the use of prophylactic antibiotics for aspiration of cystic lesions.

Huge mediastinal cystic lesion: a case report

Huge mediastinal cystic lesion: a case report

Combined adrenal and mediastinal cystic lesion

Combined adrenal and mediastinal cystic lesion