Solitary Cyst Research Articles

In Silico Modeling of Stress Distribution in the Diseased Ankle Joint.

Background/Objectives: Osteoarthritis is a feature of the aging process. Here, we adopted in silico 2D finite element modeling (FEM) for the simulation of diseased ankle joints. We delved into the influence of body weight intensity on the stress distribution caused by subchondral cysts imitating degenerative age-related arthritic changes. Methods: FEM was performed using virtually generated pictorial schemes of the ankle joint skeletal contour. It included a constellation of scenarios with solitary or multiple cysts, or the lack thereof, located centrally, peripherally, or both in the talus and tibia at increased fixed levels of body weight. Results: The modeling showed that the highest stress was in the presence of a solitary central cyst in the talus and two centrally located cysts in the talus and the tibia, with the averaged values of 1.81 ± 0.52 MPa and 1.92 ± 0.55 MPa, respectively; there was a significant increase compared with the 1.24 ± 0.35 MPa in the control condition without cysts. An increase in body weight consistently increased the strain on the ankle joint. In contrast, peripherally located cysts failed to affect the stress distribution significantly. Conclusions: We conclude that subchondral central cysts substantially enhance the stress exerted on the ankle joint and its vicinity with body weight dependence. FEM's ability to predict the location and magnitude of subchondral stress changes when confirmed in clinical trials might help to optimize the management of age-related degenerative joint changes.

Predictive Factors of Pulmonary Hydatid Complications in Children

BackgroundPulmonary echinococcosis in children has frequent and severe complications. The aim of our study was to determine predictive factors of pre and postoperative complications of pediatric pulmonary hydatid cyst. MethodsWe conducted a retrospective descriptive and analytic study conducted from January 2010 to December 2018. The study population was divided into two groups to determine predictive factors of pre- and post-operative complications of pediatric pulmonary echinococcosis. Data were analyzed by IBM SPSS 21.0. A p-value of 0.05 was accepted as significant. ResultsThe study included 106 boys and 94 girls with a median age of 8 years. One hundred and thirty-eight patients (69%) had complicated pulmonary hydatid cyst preoperatively. Univariate analysis identified 12 predictive factors of pre-operative complications: rural origin (p = 0.0001), hydatid contact (p < 0.001), long period between the onset of symptoms and the first medical consultation (p = 0.0001), the autumn and the winter (cold seasons) (p = 0.0001), chest pain (p = 0.0001), hemoptysis (p = 0.023), fever (p = 0.0001), right side (p = 0.01), apical and para hilar location (p = 0.01), superior lobe (p = 0.05), superior right lobe (p = 0.0001), cyst size>5 cm (p = 0.02), positive hydatid serology (p < 0.0001). It identified 2 predictive factors of post-operative complications: giant cyst (p = 0.009) and not performing a capitonnage (p = 0.016). Multivariate analysis showed 4 independent pre-operative predictive factors of complications: rural area (p < 0.0001), fever (p = 0.006), right side (p = 0.02) and positive hydatid serology (p < 0.001). It identified 2 postoperative independent predictive factors of complications: not performing. capitonnage (p = 0.029) and solitary hydatid pulmonary cyst (p = 0.02). ConclusionPulmonary hydatid cyst management in children needs a thorough appreciation of independent predictive factors of pre and postoperative complications in order to reduce their morbidity.

Peribiliary cysts: uncommon mimickers of hepatic and biliary cystic lesions.

Peribiliary cysts (PC) are dilatations of the extramural peribiliary glands, with a very characteristic imaging pattern in the contexts of hepatobiliary diseases, idiopathic portal hypertension, adult-type polycystic disease of the liver and kidneys, solitary nonparasitic cysts, and systemic infections. The clinical relevance of PC is related to the fact that their presence may indicate underlying pathologies (such as those mentioned above) and may be considered as a potential marker of liver disease progression. Although imaging findings are quite characteristic, recognizing their main differential diagnoses, including malignancies, can be challenging but are essential to avoiding diagnostic errors.

Retrospective Evaluation of Adult Hydatid Cyst Cases

Aim: The aim of this study was to evaluate the characteristics of adult patients followed up for hydatid cysts disease. Method: Patients over the age of 18 years who were diagnosed with hydatid disease, between January 2015 and September 2021 were included in the study. The clinical, laboratory and radiologic characteristics of the patients were evaluated retrospectively. Results: The study included 66 patients. 59.1% of the patients were female and the mean age was 40.9±15.60 years. The most common presenting symptom was abdominal pain (42.4%). The most common sites of involvement were the liver (78.8%) and lung (18.2%). The majority of patients had solitary cysts (84.8%). The most common finding in laboratory tests was elevated total IgE (74.1%). The indirect hemagglutination (IHA) test was positive in 77.4% of the patients tested. Conclusion: In our study, it was concluded that hydatid cysts are most commonly seen in the liver, often with single organ involvement, and that elevated total IgE in laboratory diagnosis may be helpful in the diagnosis of hydatid cyst disease, although it does not make a definitive diagnosis.

Multimodal imaging of solitary pigmented vitreous cyst

Multimodal imaging of solitary pigmented vitreous cyst

Disseminated multiloculated peritoneal inclusion cysts: Bubble trouble in belly.

Multiloculated peritoneal inclusion cysts, usually arise from peritoneal mesothelium lining the serous cavity of the abdomen, pelvis and retroperitoneum. These lesions can be incidentally found on imaging or during surgery, and confirmation of the diagnosis is done by radiological imaging, histomorphology and immunohistochemical findings. Although fewer than 200 cases of solitary peritoneal inclusion cysts have been reported, their occurrence in a disseminated fashion has hardly ever been described in literature. Herein, we report a case of multiloculated peritoneal inclusion cysts that involved the whole abdominal and pelvic cavity and were successfully treated with surgery.

Diagnosis and Surgical Treatment of a Renal Cyst Causing Unilateral Lameness in a Golden Eagle (Aquila chrysaetos).

This report describes the diagnosis and treatment of a benign renal cyst in an adult, female golden eagle (Aquila chrysaetos) presented for unilateral leg lameness. A cyst at the cranial division of the left kidney was diagnosed by computed tomography and was suspected of compressing the lumbosacral nerve plexus, resulting in limb lameness. The renal cyst was incompletely excised because the cyst wall was closely adhered to the kidney parenchyma and local blood supply. Fluid analysis and surgical biopsy of the cyst and left kidney confirmed the diagnosis of a benign renal cyst. No evidence of an infectious, inflammatory, or neoplastic etiology was noted. Postoperatively, the eagle's lameness resolved and the bird was ultimately released following recovery. During treatment for the renal cyst, the eagle was concurrently found to have increased serum titers on elementary body agglutination for Chlamydia psittaci and a positive titer for Aspergillus species antibody testing. The bird was administered doxycycline, azithromycin, and voriconazole for treatment of these potential pathogens prior to release. Unfortunately, the eagle was found dead 86 days postrelease due to an unknown cause. To the authors' knowledge, this is the first report of a golden eagle with a benign solitary renal cyst causing unilateral lameness secondary to nerve compression that was resolved with surgical excision.

Solitary retroperitoneal hydatid cyst masquerading as pseudocyst of pancreas

Primary retroperitoneal hydatid cyst is a rarity. Literature on this topic is sparse with anecdotal case reports. Hence the condition poses both a diagnostic and therapeutic dilemma to the attending surgeon. The objective of reporting this case is to highlight the challenges faced by the surgeon in diagnosing and treating this uncommon entity. A 70-year-old man presented with epigastric pain and discomfort accompanied by abdominal mass extending over the epigastric and right hypochondriac region. CECT revealed a cystic lesion in the retroperitoneal, peripancreatic region. The cystic lesion was diagnosed as a primary retroperitoneal hydatid cyst at the time of surgical intervention. Partial cystectomy was performed due to dense adhesions between head of pancreas and the cyst wall. A high index of suspicion for a primary retroperitoneal hydatid cyst is necessary especially in patients who hail from rural agricultural areas. CECT is diagnostic and provides information regarding site, size, nature and relationship to the adjacent organs and blood vessels. Complete cystectomy is the treatment of choice. However, if dissection is difficult then a partial cystectomy with utmost precaution to prevent spillage of contents is the best option.

Solitary vitreous cysts: a series of case reports

Solitary vitreous cysts: a series of case reports

Influence of a simple cyst on kidney function.

The aim of the study was to estimate the influence of a simple kidney cyst on kidney function and to determine indications for surgical treatment. In this prospective cohort study, we analyze data on 109 patients who sought counseling with a simple kidney cyst. Patients with solitary cyst of the right or left kidney, grade I-IIF according to the Bosniak classification, were included. Split glomerular filtration rate (sGFR) was calculated. The maximum size of the cyst, single kidney volumes (SKV) and the volume of the lost (atrophied) parenchyma were estimated with computed tomography (CT) scan of the urinary tract with contrast. The average difference between the sGFR of a healthy and affected kidney cyst was 11 [8.70; 13.44] ml/min, which is a statistically significant value (p = 0.001). Correlation analysis revealed a statistically significant relationship between the proportion of lost parenchyma and the maximum cyst size: p = 0.37 with 95% CI [0.20; 0.52] (p = 0). A multivariate logistic regression model showed that a statistically significant factor influencing the likelihood of a significant decrease in sGFR is the percentage of lost kidney parenchyma (OR = 1.13; p = 0). The growth of kidney cyst causes atrophy of the renal parenchyma and a decrease in the sGFR of the affected kidney. An increase in the volume of the atrophied parenchyma leads to a decrease in the sGFR of the affected kidney.

99mTc-DMSA renal cortical scanning: a comparison of planar, SPECT, and SPECT/CT imaging for the detection of renal cortical scarring

BackgroundThe best way to assess renal cortical scarring is planar scintigraphy with 99mTc-dimercaptosuccinic acid (DMSA), while the value of single-photon emission computed tomography/computed tomography (SPECT/CT) is not well validated. The aim of the present study was to assess the value of planar, SPECT, and SPECT/CT scanning using 99mTc-DMSA in detecting renal cortical scarring.MethodsPatients with clinically suspected renal cortical scar were included in this prospective cohort. 99mTc-DMSA Planar images were obtained approximately 3–4 h after intravenous injection (IV) of 185 MBq of the tracer. SPECT/CT scans were obtained immediately after the planar ones. An expert nuclear medicine doctor who was unaware of the patient's clinical history or any previous imaging results analyzed the images. Each kidney was given a score of 0 for no obvious defects, 1 for equivocal lesions, 2 for a single defect, 3 for several defects, and 4 for non-visualized/non-functioning kidney (in CT images). The results of each method were then compared to each other.ResultsOne hundred eighty-six kidneys from ninety-three individuals were eligible for assessment. Planar scans detected 21 kidneys with equivocal lesions, 5 with single and 7 with multiple defects. SPECT scans detected 17 kidneys with single and 40 with multiple defects, while SPECT/CT scans revealed 5 with single and 11 with multiple defects. Only 5 of the 17 kidneys with single defects diagnosed by SPECT imaging had a scar in the SPECT/CT scans, whereas the remaining 12 had a solitary cortical cyst in the CT images. Only 11 of 40 kidneys with multiple defects on SPECT were shown to have a scar in the corresponding SPECT/CT images, whereas the rest matched to either hydro-nephrotic changes or multiple cortical cysts. Four kidneys with multiple defects on the SPECT/CT images were normal in the planar readings, were ascribed to an increase in renal background activity and a reduction in renal function.ConclusionsIn cases with suspected renal cortical scar, 99mTc-DMSA SPECT/CT scanning outperformed both planar and SPECT imaging by reducing the number of false-positive SPECT readings and false-negative planar readings.

Clinical characteristics of solitary intrahepatic biliary cyst.

Solitary intrahepatic biliary cyst (SIBC) is a rare disease, and due to the lack of adequate understanding of it, SIBC is often misdiagnosed as simple liver cyst (SLC), which in turn affects the therapeutic effect. In order to arouse more attention to SIBC, combined with clinical experience in our center, this study specifically screened 3 representative cases of SIBC, and conducted a comprehensive retrospective analysis of their clinical characteristics, diagnosis and treatment process. Combined with the relevant literature, the diagnosis and treatment process of SIBC is widely discussed.

Utility of kidney ultrasonography during initial evaluation of pediatric nephrotic syndrome.

Current guidelines note a gap in high-quality evidence regarding utility of kidney ultrasonography (KUS) during initial evaluation of nephrotic syndrome (NS) due to presumed minimal change disease (pMCD). However, KUS is frequently obtained at our institution. This retrospective chart review assessed incidence and impact of abnormal sonographic findings in these patients. Patients 1-18years, newly diagnosed at our institution with NS from pMCD between 2011 and 2021, were identified. Hypertension, urinalysis, kidney function, and steroid responsiveness data were collected. Imaging findings were abstracted from radiology reports. Clinical impact of KUS was defined by actions taken in response to KUS. A total of 173 patients identified with new NS; 98 met inclusion criteria. Of these, 54% had KUS during the initial encounter. Demographic and laboratory data did not differ between those with and without KUS. KUS were abnormal in 70% of studies: increased kidney echogenicity (39.6%) and nephromegaly (35.8%) were the most common abnormal findings. Other findings included decreased corticomedullary differentiation, lobular kidney contour, solitary simple kidney cyst, and mild unilateral hydronephrosis. Steroid resistance was not associated with either nephromegaly or abnormal echogenicity. Our data showed no clinically relevant ultrasound findings causing deviations from the standard of care for pMCD. There was no association between KUS findings and steroid resistance. These data suggest there is little to no benefit from routine KUS imaging in patients with pMCD upon initial presentation. A higher resolution version of the Graphical abstract is available as Supplementary information.

Does Congenital Biliary Dilatation Todani Type II (Diverticular Type) Really Exist?

Aim of the studyThe aim of the study is to clarify the clinicopathological and biliary morphological characteristics in reported cases of diverticular congenital biliary dilatation (CBD). MethodUsing PubMed and the Japan Medical Abstracts Society, articles on possible diverticular CBD were extracted and the clinical pictures examined. We also sought evidence for definitions of diverticular CBD and the associated condition of pancreaticobiliary maljunction (PBM) using the original articles by Alonso-Lej and Todani. The characteristic biliary morphologies of cases with images were also investigated. ResultsAnalyses of 211 possible cases superficially demonstrated multiple diverticula in 12 (12%) and single diverticulum in 89 (88%), with diverticula located in the upper (n = 38, 38%), middle (n = 32, 32%), or lower (n = 26, 26%) biliary tract in and presence of intra-diverticular stones, PBM, and biliary carcinoma in 23% (n = 18), 39% (n = 25), and 11% (n = 14), respectively. However, evidence defining diverticular CBD or justifying the lack of associated PBM was not demonstrated even in the original articles. Scrutiny of the biliary anatomy in 59 cases with images showed incorrect inclusions of types I or IV-A with an irregular biliary duct wall or dilated cystic duct, periampullary choledochal diverticula, or even solitary biliary cysts. Authentic diverticular CBD, representing the diverticulum connected to the middle of the common bile duct via a thin, patent stalk was seen in only 6 cases. ConclusionReal diverticular CBD appears extremely rare. The lack of an objective definition allows wide interpretations of clinical pictures, creating inconsistencies in the diagnosis and treatment of CBD and raising questions regarding the utility of conventional classifications. Level of evidenceLevel III.

Unusual presentation of a giant solitary lung cyst in an elderly gentleman.

Unusual presentation of a giant solitary lung cyst in an elderly gentleman.

Complicated course of solitary kidney cysts in patients with a new coronavirus infection

Complicated course of solitary kidney cysts in patients with a new coronavirus infection

Kyste hydatique cérébral primitif chez l’enfant

AbstractCystic echinococcosis is a major public health concern, particularly in endemic areas. The primary cerebral hydatid cyst is rare. Specific diagnosis is mainly based on microscopic examinations of the cyst fluid. Prognosis is usually benign after surgery. Nevertheless, surgical rupture may cause complications including anaphylactic shock, recurrence or dissemination. We report a solitary and primary cerebral hydatid cyst, revealed by intracranial hypertension and gait disorders in a 7-year-old boy. Despite per-operative rupture of the cyst, the child has evolved well with a follow-up of six months.

РЕЗУЛЬТАТЫ ЭФФЕКТИВНОСТИ ЛАПАРОСКОПИЧЕСКОГО ЛЕЧЕНИЕ ЭХИНОКОККОЗА ПЕЧЕНИ

Laparoscopic surgery for liver echinococcosis is a technical option in individual uncomplicated cases of the disease, and the risk of complications after laparoscopy, especially leakage of the contents of the echinococcal cyst, has not been evaluated in larger interinstitutional studies. The purpose of this study: to study the results of laparoscopic treatment of liver echinococcosis with the identification of factors that affect specific aspects of the effectiveness of surgical approaches depending on the localization, size and stage of development of the cyst. Methods. Laparoscopy in the comparison group was performed only in patients with the primary form of liver echinococcosis – 46 patients; solitary cyst was in 26 (56.5%) cases and multiple cysts in 20 (43.5%) patients. Results. The technical aspects of performing laparoscopic echinococcectomy play a leading role in the effectiveness of the technique. Taking into account the stage of cyst development, various difficulties with manipulations occurred more often in type II-IV CE. Thus, difficulties with aspiration or removal of cyst contents were noted in only 14 (30.4%) cases, while for type CE II this indicator was 50% (6 out of 12 patients), for CE III – 44.4% (in 4 out of 9 patients), for type IV – 100% (3). Conclusions. Thus, among the main factors technically complicating laparoscopic echinococcectomy, in addition to localization, difficulties with aspiration or removal of cyst contents were identified in 54.2% of cases at the stage of development - CE II, III and IV (in 13 out of 24 patients with these types) due to the presence of many daughter cysts completely filling the mother shell (CE II, III) or thick viscous discharge (CE IV), as well as difficulties with performing perekistectomy for adequate abdominization of the residual cavity with the location of the hydatid 3/4 or more in the liver parenchyma - 19.6% (in 9 of all 46 operated).

Laparoscopic splenectomy for solitary splenic hydatid cyst: Case report.

Hydatid cyst disease is a parasitic disease caused by a type of tapeworm called Echinococcus. It is endemic to cattle-rearing regions of Africa, Asia, South Europe, the Mediterranean, the Middle East and Australia. The most common site of infection is the liver (75%). Involvement of the spleen is rare and occurs in 5% of the cases. Solitary splenic cysts are even rarer (0.5%-4%). We present a case of solitary hydatid cyst of the spleen in a 47-year-old woman. The cyst was asymptomatic and an accidental find on a full-body computed tomography after epileptic seizure and body trauma. The condition was treated successfully with albendazole, but the patient requested the cyst removed. Laparoscopic splenectomy was performed. The specimen was placed in an Endo-Bag and extracted. The patient recuperated well and was discharged on the post-operative day 5. Six months after the procedure, the patient has no complaints.

Solitary abdominal wall hydatid cyst—a rare condition

Hydatid disease is a parasitic infection by a tapeworm of the genus Echinococcus that usually presents in the liver and lungs. Presentation of the disease as a solitary abdominal wall lesion, however, is a rare entity and only nine cases have been reported in the literature thus far. We present the case of a 53-year-old Caucasian female presenting with a mass located in the left flank that was proven to be a solitary hydatid cyst intraoperatively.