Mediastinal Extension Research Articles

Parathyroid apoplexy from giant adenoma with mediastinal extension: A case report

<b>Introduction</b>: Primary hyperparathyroidism (PHPT) results from an excess secretion of parathyroid hormone (PTH), primarily due to parathyroid adenomas. These adenomas are more prevalent in women and, although rare, can develop into giant adenomas. One infrequent but notable complication of giant adenomas is parathyroid apoplexy. The aim of this manuscript is to describe the case of a Peruvian female patient diagnosed with PHPT secondary to a giant parathyroid adenoma, whose surgical treatment confirmed its apoplexy.<br /> <b>Case report</b>: A 42-year-old Peruvian woman with hypertension and stage IV chronic kidney disease presented with a non-productive cough, dysphonia, and acute chest pain, revealing a mediastinal tumor on imaging. Physical examination showed no cervical tumors, and biochemical tests revealed elevated levels of total calcium and intact PTH, while serum phosphorus and calcitonin levels were normal. Imaging elucidated a parathyroid adenoma with mediastinal extension. Surgical intervention involved right parathyroidectomy, unveiling a 6 × 6 cm tumor with cystic and hemorrhagic degeneration, confirming the diagnosis of parathyroid apoplexy from a giant adenoma.<br /> <b>Conclusions</b>: Giant parathyroid adenoma should be considered in patients presenting with a mediastinal mass and hypercalcemia. This condition can be complicated by parathyroid apoplexy in the context of PHPT. Timely imaging and surgical intervention are crucial for achieving optimal outcomes, with diagnosis confirmed through histopathology.

Bilan d’extension du cancer bronchique

The management of lung cancer patients requires a definitive diagnosis and a precise assessment of the disease extent. Pathological examination performed on tissue or cytological samples taken from the tumor, associated lymphadenopathy or an accessible metastatic site answers the first question while a set of staging techniques ensures the second. Guidelines for each technique have been issued in order to maximize diagnostic yield and allow immunohistochemical and molecular biology analyzes which impact the therapeutic strategy. The aim of this article is to discuss the different diagnostic and staging methods and to propose solutions for optimizing the diagnosis and the assessment of the anatomic extent of lung cancers. In this context, the indications and limits of the different modalities are discussed. The size of the tumor, its pleural, parietal, endobronchial and direct mediastinal extension must be specified as well as lymph node and distant extension. The clinical examination remains essential. Contrast enhanced Chest CT is systematic, unless contraindicated. 18FDG PET-CT is not always indicated but is essential in patients potentially eligible for curative treatment. Brain imaging is indicated, even in asymptomatic patients. Compliance with recommendations and adequate organization optimize patient care.1877-1203/© 2024 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Retropharyngeal Abscess Complicated by Mediastinitis in Infants

Introduction: Most paediatric upper respiratory infections are virally mediated and result in self-limiting reactive lymphadenopathy. In children younger than 5 years, retropharyngeal lymph nodes may give rise to deep neck space infections in this potential space. Retropharyngeal infections are rare after 5 years because lymph nodes undergo atrophy. Methods: We present a series of 6 cases of paediatric retropharyngeal abscesses (RPA) complicated by mediastinitis, managed at a tertiary hospital over a 4-year period. Results: All our cases presented with fever, difficulty feeding, and neck swelling. The age range was 11 weeks–11 months, and all tested negative for human immunodeficiency virus. The diagnosis and complications were confirmed on computed tomography (CT) scan. The CT scans consistently revealed RPA with varying degrees of deep neck space and mediastinal extension. All children were promptly taken to theatre for source control. Two were extubated successfully immediately after surgery, and the other 4 were extubated in the paediatric intensive care unit, with the longest duration of intubation being 3 days. Methicillin-sensitive Staphylococcus aureus (MSSA) was cultured in all 6 cases. Conclusion: Management of these cases may be challenging, and young children with RPA require close care and airway monitoring. CT or magnetic resonance imaging is essential to delineate the extent of infection. Surgical drainage should be performed when there is a large abscess, a complication occurs, or an inadequate response in 24–48 h to medical management.

Kompresivna priroda retrosternalne strume

Mediastinal masses originate from the structures of the mediastinum or neck organs and can represent primary benign or malignant tumors, as well as metastases. In most cases, they are detected through radiological imaging, such as an X-ray of the enlarged mediastinum. In the differential diagnostic approach, the acronym "the terrible T" (thymoma, teratoma, terrible lymphoma, and thyroid) is useful. A retrosternal goiter with its compressive effect can lead to changes in the voice, difficult speaking, tracheal compression, and potentially superior vena cava syndrome. Additionally, visualization techniques, thyroid hormones, and tumor markers can be helpful in the diagnostic process. We presented a patient who, during a meal, stopped eating, lost consciousness, and experienced asystole. Due to a chest injury sustained during resuscitation, a computerized tomography (CT) scan was performed. The CT scan revealed a nodular formation in the right lobe of the thyroid gland that extends through the upper thoracic aperture behind the sternum, exerting a pronounced compressive effect on the trachea. Based on the examination, it was concluded that the patient has a goiter with retrosternal and mediastinal extension, accompanied by thyrotoxicosis, which was most likely induced by the iodine contrast agent. Thyrostatic therapy was initiated, followed by surgical treatment of the retrosternal goiter. Computed tomography is the most accessible form of imaging for preoperative assessment of goiter position and its extent, while surgery remains the gold standard for treating symptomatic retrosternal goiters.

Bilan d’extension du cancer bronchique et classification TNM des CBNPC: Disease extent assessment in lung cancer and TNM classification for Non Small Cell Lung Cancer

The definitive diagnosis of lung cancer relies on pathological examination. Tissue samples (by biopsy), or cell samples (by washing, cytopuncture) are collected from the tumor, associated lymphadenopathy or from an accessible metastatic site. There are different methods of diagnostic access to an opacity suspect of bronchial cancer. Guidelines have been published for each of the techniques in order to maximize their diagnostic efficiency and to allow or immunohistochemical or molecular analyses that modify the therapeutic strategy. The first objective of this topic is to describe the different diagnostic methods and to suggest ways to optimize the diagnosis of broncho-pulmonary cancers.Establishing cTNM relies on a precise and rigorous evaluation. The second objective of this article is to present the modalities of NSCLC extension assessment, addressing the indications of imaging exams as well as their limitations. SCLC management is discussed in a specific chapter. Clinical examination remains essential. Chest Computed- Tomography (CT) scan with iodine contrast injection is systematic, unless contraindicated. The size of the tumor, its pleural, parietal, endobronchial and direct mediastinal extension should be specified as well as the lymph node extension. 18FDG PET-CT is not indicated as a first line but is essential in patients potentially eligible for curative treatment. Brain imaging is indicated, even in asymptomatic patients. Compliance with the recommendations and proper organisation optimise management of patients.The international TNM classification, accepted by both UICC and AJCC, is routinely used for non-small cell lung cancer management. The aim of this article is to review the 8th TNM classification, its practical implications and the IASLC Staging Committee proposals regarding some specific clinical situations. The new database that will inform the ninth TNM classification is discribed awiating publication of the next revision.1877-1203/© 2023 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Retropharyngeal Abscess With Mediastinal Extension: A Case Series and Review of the Literature.

Deep neck infections are common in infants and occur in several anatomic subsites including the retropharyngeal space. Retropharyngeal abscesses are significant given their propensity for mediastinal extension and can have life-threatening sequelae. We present 3 cases of retropharyngeal abscess with mediastinal extension in infants. In one case, an incompletely vaccinated 10-month-old boy presented with cough, rhinorrhea, and fever. Despite antibiotic treatment, he developed Horner's syndrome and hypoxia. A computed tomography (CT) scan showed a C1-T7 retropharyngeal abscess. He underwent transoral incision and drainage and recovered fully. In another case, a 12-month old infant presented with 8 days of fever and neck pain. A CT scan showed a retropharyngeal collection extending to the mediastinum and right hemithorax. Transoral incision and drainage and video-assisted thoracoscopic surgery thoracotomy were performed for abscess drainage. He recovered fully with antibiotics. In the third case, an 8-month-old boy presented to the emergency room following several days of fever, lethargy, and decreased neck range of motion. A CT scan showed a large retropharyngeal abscess that required both transoral and transcervical drainage. His case was complicated by septic shock, yet the patient eventually made a full recovery.

Transoral endoscopic thyroidectomy vestibular approach (TOETVA). Recommendations of the AFCE (Francophone Association of Endocrine Surgery) with the SFE (French Society of Endocrinology) and the SFMN (French Society of Nuclear Medicine)

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) can be proposed for selected patients with a thyroid volume < 45 mL and/or a nodule < 4 cm (for Bethesda category II, III or IV lesions), or < 2 cm (for Bethesda category V or VI lesions), with no suspicion of lateral nodal involvement or mediastinal extension who wish to avoid a cervical scar. Such patients should have satisfactory dental status, have been educated on the specific risks of the transoral route and the need for perioperative oral care, and also fully informed regarding the lack of proof of TOETVA effectiveness in terms of quality of life and patient satisfaction. The patient should be made aware of the possibility of postoperative pain in the neck cervical and chin, which may persist for several days to a few weeks after the intervention. Transoral endoscopic thyroidectomy should be performed in centers with expertise in thyroid surgery.

A Case of Medullary Carcinoma of Thyroid

A 50-year-old diabetic female attended in September, 2021 with a huge swelling in front of her neck, respiratory distress, hoarseness of voice, &amp; generalized weakness for 1 month. All the biochemical tests were inconclusive but S. calcitonin was high(&gt;0.08ng/ml), Fiber optic laryngoscopy revealed left vocal cord paralysis, X-ray chest revealed right sided tracheal deviation, CT-scan of Neck revealed large solid mass in thyroid with mediastinal extension &amp; cervical lymphadenopathy. Patient undergone total thyroidectomy. The specimen sent for histopathology and revealed medullary carcinoma of thyroid gland.&#x0D; AKMMC J 2021; 12(2): 104-106

A Rare Case of Spinal Extradural Teratoma With Mediastinal Extension

Abstract Introduction: Spinal extradural teratomas extending to posterior mediastinum are very rare and seldom reported. Case Report: A 4-year-old boy presented with progressive spastic paraparesis with sphincteric dysfunction was misdiagnosed as cerebral palsy. His magnetic resonance imaging showed D2-D5 extradural tumor, extending to the posterior mediastinum, causing severe thecal sac compression. Intraspinal part of the tumor was excised, and the child made a good recovery after the surgery. On histopathological examination, it was confirmed as a mature cystic teratoma. Conclusion: Spinal tumors with myelopathy may mimic cerebral palsy in children. To the authors’ knowledge, there are very few reported cases of spinal teratomas extending to the mediastinum.

Successful Sirolimus Treatment for Recurrent Pericardial Effusion in a Large Cervicomediastinal Provisionally Unclassified Vascular Anomaly: A Case Report

Provisionally unclassified vascular anomalies (PUVA) are a group of diseases with unique characteristics that make them unclassifiable within vascular tumors or malformations. We describe a PUVA as the cause of recurrent pericardial effusion and its response to sirolimus. A 6-year-old girl was referred with a cervicothoracic vascular anomaly, a violaceous, and irregular lesion in the neck and upper chest, diagnosed as "hemangioma". She had pericardial effusion at the neonatal age that required pericardiocentesis, propranolol, and corticosteroids. She remained stable for 5 years, when she presented with a severe pericardial effusion. A magnetic resonance visualized a diffuse vascular image in the cervical and thoracic region with mediastinal extension. The pathological study showed a vascular proliferation in the dermis and hypodermis with positive staining for Wilms' Tumor 1 Protein (WT1) and negative for Glut-1. Genetic testing found a variant in GNA14 , for which the diagnosis of PUVA was established. When a pericardial drain was placed without response, treatment with sirolimus was started with resolution of the effusion. Sixteen months later, the malformation is stable and there has been no recurrence of pericardial effusion. In a significant group of patients, definitive diagnosis is not possible despite pathological and genetic analysis. Mammalian target of rapamycin inhibitors may become a therapeutic option if symptoms are severe enough, with a low rate of reported side effects.

Mediastinal extension of a progressively enlarging pseudocyst treated by EUS-guided transgastric drainage in a child: A rare case report (with video).

Mediastinal extension of a progressively enlarging pseudocyst treated by EUS-guided transgastric drainage in a child: A rare case report (with video).

Computed Tomography Findings Affecting the Decision of Sternotomy in Substernal Goiter.

Although thyroidectomy is completed with a cervical incision in most patients with substernal goiter (SG), sternotomies may be required occasionally. The purpose of this study is to examine computed tomography (CT) findings that may predict the need for sternotomy in SG surgery. Neck-thoracic CT images of patients who underwent total thyroidectomy with the diagnosis of SG between 2013 and 2022 were retrospectively examined. The patients (n=41) were divided into two groups: sternotomies (n=6) and cervical (n=35). Preoperative pathological data, CT findings, and postoperative complications of the patients were recorded. The total thyroid volume of the sternotomy group (280.75±127.01 mm3) was significantly greater than that of the cervical group (155.38±74.18 mm3) (p=0.015). The retrosternal thyroid volume (mm3), thyroid craniocaudal, and anterior-posterior dimensions (mm) were significantly greater in the sternotomy group (p=0.001, p<0.001, and p=0.004, respectively). While the majority of mediastinal extension degrees in the cervical group were grade 1 (80%), grade 2 (83%) predominated in the sternotomy group (p=0.001). The radiological findings of total thyroid volume, retrosternal thyroid tissue volume, retrosternal thyroid length, thyroid anterior-posterior dimension, and mediastinal extension degree on CT are valuable in predicting the decision to perform a sternotomy in SG surgery.

Mediastinal extension of amoebic liver abscess: A case report on the rare thoracic complication of Entamoeba histolytica

Amoebic liver abscess is one frequently encountered intra-abdominal infection, caused by Entamoeba histolytica and has various abdominal and thoracic life-threatening complications. Herein, describe a case of a 30-year-old female, who suffered from multiple amoebic liver abscesses and presented with massive right-sided pleural effusion. She was managed with recommended antibiotics and pigtail catheter for liver abscess and an intercostal drainage tube for massive pleural effusion. However, postintercostal drainage, her chest X-ray demonstrated a right mediastinal shadow, which was confirmed as an intrathoracic extension of the hepatic liver abscess on computed tomography. An ultrasound-guided pigtail catheter was manipulated and placed at the site of thoracic communication. This led to clinical and radiological improvement, but unfortunately, she developed ventilator-acquired pneumonia and died due to her illness. The case represents an uncommon complication of amoebic liver abscess, which is rarely described and adds more knowledge on the thoracic complexities of this infectious disease.

Incidentally detected retrosternal goitre with posterior mediastinal extension causing compression of airway: a case report

&lt;p class="abstract"&gt;Retrosternal goitre (RG) is an enlarged thyroid gland which extends below the clavicle and sternum. Most patients have slow-growing enlargement without any symptoms but may develop symptoms related to compression of aerodigestive tract like dyspnoea, choking, sleep disturbance, dysphagia and hoarseness. Surgical removal is the treatment of choice either through a cervical approach or combination with sternotomy or thoracotomy. Here we present a case of a 51 years female without any symptoms, detected incidentally to have mediastinal mass on imaging during routine health checkup. On evaluation, she was found to have no significant neck swelling or any evidence of vascular obstruction or neurological compression. Contrast enhanced computed tomography showed large heterogeneous mass lesion extending from posteroinferior aspect of (right) thyroid lobe extending into mediastinum till tracheal bifurcation. Due to the mediastinal extension, multispecialty team approach involving oncosurgeon, ear nose and throat (ENT) surgeon and cardiothoracic surgeon was done. The patient underwent (R) hemithyroidectomy with excision of posterior mediastinal component through combined cervical and mediastinal approach under general anaesthesia. Histopathological examination revealed adenomatous goitre. Post operatively patient was symptom free and is on regular follow-up.&lt;/p&gt;

Small Cell Lung Carcinoma On Contrast enhanced Chest Computer Tomography, Are There Special Characteristics be Found ?

Background: Small Cell Lung Carcinoma is the most common primary pulmonary neuroendocrine malignancy. Usually patients present with metastatic disease at diagnosis and poor prognostic. Early and accurate diagnosis is important for SCLC. A contrast enhanced chest CT scan is needed to show more clearly the abnormalities detected on chest X-ray so that it can help to diagnose and reveal the extent of mediastinal invasion. Method: This study was a descriptive type with a retrospective approach. In 30 patients who underwent contrast enhanced chest CT with histopathologically proven SCLC at Dr. Soetomo Hospital, Surabaya. Assessing feature of SCLC based on age, gender, location, and mediastinal extension (airways and vascular). Results: Total sample were 30 patient, with 23 male subjects (76,6%) and 7 female subjects ( 23,3%), The age range of the study was between 31 years and 80 years, with an average age of 62 years, with incidence rate in males being higher than females. it was found that type I 3,3% (n = 1), type II a 13,3% (n = 4), type II b 30% (n = 9), type III a 3,3% (n = 1), III b 23,3% (n = 7), III c 10% (n = 3), type IV 13,3% (n = 4), and type V 3,3% (n = 1). Involvement airways approximately 60% (n=18), either involving one bronchus or 2 or 3 bronchial segments. About 86,6 % (n=26) prove to involve vascular with involvement pulmonal artery in 73,3% (n=22), superior vena cava in 13,3% (n=4) and combination of pulmonal artery and superior vena cava about 6,6% (n =2). Conclusion: Feature of contras enhanced chest CT scan found in SCLC is hilar mass with ipsilateral mediastinal extension involves the main bronchi with 2 or more segmental bronchi. Vascular involvement particularly the pulmonal artery was found.

Retrosternal Thyroid with Mediastinal Extension: Surgical Approach and Management.

To assess the clinical presentation and the need for sternotomy as an additional approach for surgical excision of goitre with retrosternal extension. It was a retrospective review of 22 patients (13 female, 9 male; mean age: 50.36years) who underwent total thyroidectomy for retrosternal extension. Between-group differences were assessed using Chi-square or Fisher exact test, appropriate P values < 0.05 were considered indicative of statistical significance. All cases were assessed by CT scan of neck and thorax to confirm mediastinal extension. The symptoms most commonly reported were dyspnoea 6 (27%), hoarseness (13%) and dysphagia 2 (9%). The retrosternal extent was grade 1(thoracic inlet to aortic arch) in 11 cases and grade 2(aortic arch to pericardium) in 11 cases. Overall, 13 (59%) patients showed CT evidence of tracheal deviation. Patients were divided into two groups based on the surgical approach: trans-cervical (n = 13) and trans-cervical plus trans-sternal (n = 9). The radiological extent of retrosternal descent of goitre in the mediastinum showed no significant correlation with the requirement of sternotomy in our cohort (odds ratio for sternotomy in grade 2 extension: 1.45). The need for sternotomy in cases of retrosternal thyroid does not depend on the radiological extent of tumour alone. It depends on multitude of factors like presence of dysphagia, dyspnoea or hoarseness. Preservation of recurrent laryngeal nerve and parathyroid glands is difficult in the restricted thoracic inlet space. Sternotomy is required for complete excision and preservation of major mediastinal vessels.

Bilan du cancer broncho-pulmonaire non à petites cellules : quel bilan anatomique ?

The definitive diagnosis of lung cancer relies on pathological examination. Tissue samples (by biopsy), or cell samples (by washing, cytopuncture) are collected from the tumor, associated lymphadenopathy or from an accessible metastatic site. There are different methods of diagnostic access to an opacity suspect of bronchial cancer. Guidelines have been published for each of the techniques in order to maximize their diagnostic efficiency and to allow either immunohistochemical or molecular analyses that modify the therapeutic strategy. The first objective of this topic is to describe the different diagnostic methods and to suggest paths to optimize the diagnosis of broncho-pulmonary cancers. Establishing cTNM relies on a precise and rigorous evaluation.The second objective of this article is to present the modalities of NSCLC extension assessment, addressing the indications of imaging exams as well as their limitations. Clinical examination remains essential. Chest Computed-Tomography (CT) scan with iodine contrast injection is systematic. The size of the tumor, its pleural, parietal, endobronchial and direct mediastinal extension should be specified as well as the lymph node extension. 18FDG PET-CT is not indicated frontline, but is essential in patients potentially eligible for curative treatment. Brain imaging is indicated, even in asymptomatic patients. Compliance with such recommendations and proper organisation is needed to optimise patients management.1877-1203/© 2022 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Depth of mediastinal extension can predict sternotomy need for substernal thyroid goiters

BackgroundSurgical excision of substernal thyroid goiters is usually achieved through a conventional transcervical approach, and transthoracic excision is rarely necessary. Currently, there are no clear guidelines for substernal thyroid goiters that may require a transthoracic approach. This study examined what preoperative factors were significantly associated with transthoracic surgical excision for substernal thyroid goiters. MethodsA retrospective review of prospectively collected data of 109 patients with substernal thyroid goiters from a single institution was performed. The patients were stratified by transcervical and transthoracic approaches for substernal thyroid goiters. The factors possibly predictive of a transthoracic approach, including substernal extension beyond the thoracic inlet, patient-reported symptoms, tracheal deviation, and malignancy, were analyzed. Demographics including age, sex, and race, among others, were also studied. ResultsOf 1,080 patients who underwent surgical resection for multinodular goiter, there were 109 (10%) patients with substernal thyroid goiters. Of the substernal thyroid goiter group, 11 (10%) patients underwent partial sternotomy, whereas 6 (5.5%) underwent total sternotomy. On logistic regression, only substernal component of the thyroid goiter extending beyond the sternal notch into the mediastinum was statistically significant in predicting sternotomy (odds ratio 3.43, confidence interval 1.65–6.41, P < .001). Substernal thyroid goiters with mediastinal extension of ≥5 cm beyond the sternal notch showed a sensitivity of 94% and specificity of 86.5% to predict need of sternotomy. ConclusionPatients with substernal thyroid goiters who exhibit progressive enlargement and/or compressive symptoms should undergo surgical excision. Although most are removed through the conventional transcervical approach, substernal thyroid goiters with a depth of mediastinal extension ≥5 cm have a high likelihood of requiring sternotomy.

A Rare Cause of Peri-esophageal Cystic Lesion

A Rare Cause of Peri-esophageal Cystic Lesion

Combined thoracoscopic and axillary subcutaneous endoscopic thyroidectomy: a novel approach for cervicomediastinal goiters.

After our group described the first remote-access thyroidectomy series in 2000, the procedure has been further developed. Although a thoracoscopic approach with a conventional open cervical incision for thyroid goiters with mediastinal extension has been performed at many institutions, remote-access thyroidectomy for cervicomediastinal goiters has not been established. We have performed combined thoracoscopic and axillary subcutaneous endoscopic thyroidectomies (axillo-thoracic endoscopic thyroidectomies). Here, we describe a novel technique for performing a remote-access thyroidectomy for a cervicomediastinal goiter (CMG). The patients with CMGs who agreed to an axillo-thoracic endoscopic thyroidectomy at one of two hospitals in Japan underwent a remote-access thyroidectomy. We performed the axillo-thoracic endoscopic right or left hemithyroidectomy successfully, but most of the patients did not require the thoracoscopic procedure. None of the patients had complications, and none was converted to an open thyroidectomy. Most thyroid goiters with substernal extension can be removed by the axillary approach, but some cases require a thoracoscopic approach. The novel approach described herein (axillo-thoracic endoscopic thyroidectomy) enables the safe excision of a CMG with high patient satisfaction for selected patients.