Achado Radiológico de Cisto Pericárdico / Radiologic Finding of Pericardial Cyst

Mulher de 46 anos de idade, em acompanhamento porinfecção cutânea por Bukhoderia pseudomallei em membrosuperior esquerdo, realizou radiografia de tórax para descartaracometimento pulmonar, que evidenciou hipotransparênciaem lobo inferior esquerdo (Figura 1A). Posteriormente, foisubmetida a tomografia de tórax que demonstrou coleçãolíquida, sem realce pelo meio de contraste, medindo 8cm no maior eixo axial, ocupando o seio cardiofrênicoesquerdo (Figura 1B). O ecocardiograma transtorácico (ECO)mostrou função sistólica preservada (FE 62% pelo Teichholz),espessamento pericárdico discreto e cisto pericárdico emregião posterior e em ponta do coração, contendo traves defibrina (Figura 2). Posteriormente, a paciente foi submetidaa drenagem percutânea do cisto guiada por US (citologia:hemácias 0, leucócitos 1.000, 60% mononucleares e 40%neutrófilos; cultura negativa). O ECO realizado um mês apósa drenagem demonstrou discreto espessamento pericárdico(4 mm) e ausência de derrame pericárdico. Paciente segueem tratamento ambulatorial com o infectologista.Cistos pericárdicos são anomalias congênitas raras egeralmente benignas. Representam 6% das massas mediastinaise 33% de todos os cistos do mediastino. A grande maioriados cistos é assintomática e geralmente é achado incidentalem exames de imagens que podem ser confundidos comaneurisma da artéria coronariana, neoplasias e pneumonia.Complicações como a ruptura do cisto, compressão cardíacae até mesmo morte súbita já forma descritas, porém sãoincomuns. Pode-se adotar uma conduta conservadora emcasos assintomáticos desde que seja possível o seguimentodo paciente, de forma a garantir um curso benigno em que ocisto pericárdico pode involuir espontaneamente...

Post extubation negative pressure pulmonary edema due to posterior mediastinal cyst in an infant.

A 3‑month‑old male child underwent uneventful inguinal herniotomy under general anesthesia. After extubation, airway obstruction followed by pulmonary edema appeared for which the baby was reintubated and ventilated. The baby made a complete recovery and extubated after about 2 h. A post‑operative computed tomography scan revealed a posterior mediastinal cystic mass abutting the tracheal bifurcation. Presumably, extrinsic compression by the mass on the tracheal bifurcation led to the development of negative pressure pulmonary edema.

Grande cisto pericárdico manifestando-se com compressão das câmaras cardíacas direitas / A large pericardial cyst presenting with compression of the right-side cardiac chambers

Cistos pericárdicos são raros, comumente congênitos, com localização mais frequente no ângulo cardiofrênico direito. O diagnóstico é suspeitado pela radiografia de tórax anormal. O presente relato descreve um caso de cisto pericárdico com aspecto radiográfico atípico, em um paciente atleta, manifestando-se clinicamente com sintomas de insuficiência ventricular direita. O diagnóstico foi sugerido pelo ecocardiograma transesofágico e confirmado pelo estudo anatomopatológico.

Pericardial cysts are rare, usually congenital. Cysts frequently occur in the right cardiophrenic angle and their diagnosis is usually suspected after an abnormal chest X ray. The present case report shows a case of pericardial cyst with atypical radiographic aspect in an athletic patient who presented clinical with symptoms of right ventricular failure. The diagnosis was suggested by echocardiogram and subsequently was confirmed by pathologic examination.

Pseudoquiste de páncreas con extensión a mediastino / Pancreatic pseudocyst extended to the mediastinum: case report

We report a 53 years old male consulting for chest pain and dyspnea. On physical examination, an epigastric mass was detected. A TC scan showed a collection located in the omental bursa, which protruded over the posterior gastric wall and ascended to the mediastinum. Due to the presence of pancreatic calcifications, a pancreatic pseudocyst was suspected. The mediastinal cyst was drained percutaneously, leaving pig tail drainage in the cavity. Afterwards a cyst excision and Roux en Y gastrostomy was performed. After the surgical procedure the cyst became infected, requiring antimicrobials. After two weeks he was discharged in good conditions.

Los pseudoquistes de páncreas representan el 75 por ciento de las lesiones quísticas del páncreas y generalmente se circunscriben en el abdomen. Se presenta el caso de un paciente con un pseudoquiste de páncreas con extensión transhiatal a mediastino. Estos casos deben sospecharse mediante una historia clínica detallada y preguntando por antecedentes de dolor abdominal previo porque la clínica con la que se suelen manifestar es muy poco específica. El tratamiento de los pseudoquistes con extensión a mediastino debería ser el drenaje definitivo, bien de forma quirúrgica o endoscópica.

Evolução de um cisto pericárdico após tratamento de pericardite aguda / Development of a pericardial cyst after treatment of acute pericarditis

Relata-se o caso de uma paciente internada com quadro de pericardite aguda, de provável etiologia viral, em que foi detectada presença de cisto pericárdico. Houve recidiva de sintomas da pericardite uma semana após tratamento com AAS por sete dias. Após uso de AAS por um mês e colchicina por três meses com remissão total dos sintomas, houve redução importante no tamanho do cisto pericárdico.

Mediastinal pseudocysts in chronic pancreatitis with spontaneous resolution.

A 39 year old male, chronic alcoholic for 12 years, presented with recurrent abdominal pain for last 3 years. He was admitted in our hospital with history of breathlessness, chest pain and abdominal pain for last 20 days. On investigation he had raised total leukocyte count with elevated serum amylase and lipase. Chest radiograph showed mediastinal widening and ultrasound of abdomen revealed chronic pancreatitis with peripancreatic pseudocysts. CT scan revealed extensive phlegmonous collections with cyst formation in the mediastinum which extended from the level of thoracic inlet to below the level of the diaphragm. There were in addition multiple pancreatic and lesser sac pseudocysts. Patient was stable and was hence closely observed on conservative treatment with complete abstinence from alcohol. We performed no surgical, endoscopic or radiological interventions. A repeat CT performed after 14 weeks showed almost complete resolution of the mediastinal pseudocyst. Overall adequate conservative management and timely imaging follow-up before planning any intervention helped us to see that there can be spontaneous resolution of mediastinal pseudocysts.

Dispnéia por compressão de estruturas mediastinais por cisto pericárdico / Dyspnea through compression of mediastinal structures due to pericardial cyst

Caso de uma paciente com 65 anos, apresentando dispnéia aos esforcos e dor torácica lateral direita como principais sintomas de um cisto no pericárdio, de aproximadamente 8 cm. Os exames físico, bioquímico e eletrocardiográfico não evidenciaram alteracões. O resultado dos exames de radiografia de tórax, tomografia computadorizada e ecocardiograma foi sugestivo de cisto pericádico. Com base nessas evidências clínicas a paciente foi submetida à toracotomia em região torácica lateral direita e realizada excisão completa da massa mediastinal com remissão total dos sintomas.

Primary Idiopathic Chylopericardium Associated with Cervicomediastinal Cystic Hygroma

Chylopericardium is a rare clinical entity in which chylous fluid accumulates in the pericardial cavity. We report a case of primary idiopathic chylopericardium associated with multiple, small cervicomediastinal cystic hygromas occurring in an asymptomatic 43-year-old woman with no history of trauma, thoracic surgery, malignancy, infection or tuberculosis. Echocardiography showed a large amount of pericardial effusions and pericardial fluid analysis revealed inappropriately elevated triglyceride. We did not demonstrate communication between the thoracic duct and the pericardial sac by lymphangiography and chest computed tomography. She successfully responded to 30 days of continuous pericardial drainage and 15 days of a medium-chain triglyceride diet after 30 days of total parenteral nutrition. Follow-up echocardiography 6 months after treatment commencement showed a minimal reaccumulation of pericardial fluid without symptom. We conclude that if a patient is asymptomatic and can well tolerate daily life, surgery including pericardiectomy or ligation of the thoracic duct is not necessarily required.

Preoperative aspiration for anterior mediastinal cyst with respiratory distress.

We report a 5-month-old boy who presented with an anterior mediastinal cystic teratoma. Pre-operative symptoms of respiratory distress secondary to airway obstruction were markedly reduced by percutaneous aspiration. Aspiration was also beneficial in easily ventilating the baby during the surgical procedure.

Mediastinal enteric duplication cyst containing aberrant pancreas.

OBJECTIVE: The purpose of the study is to report a unique association of clinical and pathological findings in a neonate. Foregut enteric duplication cysts--rare developmental anomalies that are associated with midline vertebral fusion anomalies. METHODS: We had a neonate with foregut duplication cyst who presented at birth with respiratory distress. The child also had associated communicating hydrocephalus. The patient underwent excision of the duplication cyst along with a ventriculo-peritoneal shunt. RESULT: The excised specimen revealed a duplication cyst lined by aberrant pancreatic tissue. CONCLUSION: The present case demonstrates histologically the presence of both pancreatic and gastric tissue.

Doença cística traqueobrônquica / Tracheobronchial cystic disease

Cistos aéreos que emergem anormalmente da traquéia e/ou brônquios de maior calibre são doença extremamente rara. Na literatura encontram-se poucas descrições de casos isolados de cistos paratraqueais associados a pneumopatias crônicas. Relatamos dois casos dessa entidade clínica, rara, em membros de uma mesma família: o pai das pacientes faleceu dessa doença com 43 anos de idade e as duas filhas encontram-se em tratamento. O quadro clínico é semelhante ao da supuração pulmonar crônica. O diagnóstico foi firmado através de broncovideoscopia e tomografia computadorizada de tórax com reconstrução em 3D e broncoscopia virtual. As pacientes estão sob observação e tratamento clínico paliativo.

Mediastinal enterogenic cyst presenting as paraplegia--a case report.

A rare case of a mediastinal enterogenic cyst with an intraspinal extension through a anterior vertebral defect presenting with paraplegia in a 10 year boy is presented. Laminectomy and the trans-thoracic excision of the cyst resulted in the complete recovery of the neural deficit.

Intrathoracic enteric foregut duplication cyst.

A one month old male child presented with respiratory distress since day 10 of life. There was intercostal retraction and decreased air entry on the right side. Investigations revealed a well defined cystic mass in the posterior mediastinum with vertebral anomalies, the cyst was excised by posterolateral thoracotomy. Histopathology revealed it to be an enteric foregut duplication cyst.

Cisto enterógeno de localizaçäo torácica / Mediastinal foregut cyst

Relato de um caso de cisto enterógeno de localizaçäo torácica em uma criança do sexo masculino com história de pneumonias de repetiçäo. Foram realizados exames radiológicos que demonstraram massa cística médio posterior à direita, sem comunicaçäo com o esôfago. Foi realizado toracotomia, com posterior diagnóstico anátomo-patológico

Chylous cysts of the mediastinum: report of a case and review of the literature

Life-threatening spontaneous chylothorax is a rare clinical entity. Correct diagnosis and understanding of its pathogenesis is paramount in order to apply definite surgical treatment. A case of a ruptured multilocular chylocyst around the thoracic duct and cysterna chyli is presented. Multiple bilateral aspirations, right thoracostomy, right thoracotomy, a frustrated attempt to ligate the thoracic duct, and an attempt to insert a pleuroperitoneal shunt, were all unsuccessful. Definite surgery accomplished rehabilitation of the patient after a 5 1/2 month hospitalization. Revision of the literature and vindicative historical facts are presented

Acquired pericardial cyst with uncommon complications: case report and literature review

CONGENITAL pericardial cysts constitute 7% of all mediastinal masses. Since acquired cysts and their complications, such as spontaneous rupture and presentation with hemoptysis, are rarely reported, we elect to report the present case of pericardial cyst that had a number of unusual features, notably the location of the cyst, gross and microscopic pathology, and clinical symptomatology