Primary mediastinal hydatid disease leading to popliteal artery hydatid cyst embolization

Hydatid disease is a zoonosis caused by Echinococcus granulosus. Infected dogs release eggs through their feces and the eggs infect humans through food and water. The most common locations of hydatid cysts are the liver and lungs, but primary mediastinal involvement, though rare, can be encountered. We report on a 16-year-old female with a primary mediastinal hydatid cyst leading to popliteal arterial embolization. The mediastinal lesion was treated with partial pericystectomy with removal of the germinal membrane and prophylactic albendazole. In endemic areas, it is important to consider hydatid cysts in the differential diagnosis of an acute arterial occlusion

Amiloidose ganglionar mediastinal em paciente com sarcoidose / Mediastinal lymph node amyloidosis in a patient with sarcoidosis

Paciente masculino, 27 anos, com sintomas respiratórios, linfonodomegalia cervical anterior bilateral e hepatomegalia. Os estudos de imagem evidenciaram linfonodomegalia hilar bilateral e infiltrado pulmonar. O paciente foi submetido a biópsias pulmonar e hepática, que evidenciaram presença de granulomas não caseosos. Também foi submetido à biópsia de linfonodo hilar, que revelou a presença de material amilóide. Os achados clínicos, radiológicos e histopatológicos foram compatíveis com sarcoidose e amiloidose ganglionar. A associação entre sarcoidose e amiloidose é raramente descrita.

A 27-year-old male patient presented with respiratory symptoms, bilateral enlargement of the cervical lymph nodes and enlarged liver. In the imaging studies, bilateral enlargement of the hilar nodes was observed, together with pulmonary infiltrate. The patient was submitted to lung and liver biopsies, which revealed noncaseating granulomas. The clinical, radiological and histopathological findings were consistent with sarcoidosis and lymph node amyloidosis. The combination of sarcoidosis and amyloidosis has rarely been reported.

Idiopathic mediastinal fibrosis presenting as mediastinal compression syndrome.

Mediastinal compression syndrome is a commonly seen entity. Mediastinal compression, mostly due to a space-occupying lesion, is distinct and different from mediastinitis/mediastinal fibrosis, which could also lead to superior vena cava syndrome. Idiopathic mediastinal fibrosis should also be considered as differential diagnosis of mediastinal structures with various radiological, CT and MRI and histological features if feasible. Medical therapy is disappointing while surgical cure has limitations. This interesting patient presented as mediastinal compression syndrome, which on investigation was postulated as idiopathic mediastinal fibrosis, as a diagnosis on exclusion of other causes, which is rare, hence is being reported.

Mediastinal diseases: clinical and therapeutic aspects

Background: Mediastinal affections are common and encompass a great number of different diagnoses. Objective: To analyze the clinical aspects and the therapeutic response of 114 patients with mediastinal diseases treated at the Thoracic Surgery Department of Santa Casa de São Paulo Hospital, from 1979 and 1997. Method: The patients were grouped according to the benign or malignant nature of the disease, and the two groups were compared regarding gender, age bracket, symptomatology, topography of the lesion, mortality, and response to treatment. Results: Sixty-three patients had neoplasia: 31 benign and 32 malignant. Fifty-one cases were not neoplastic. No difference was found between the groups regarding gender or age bracket. Half of the patients were between 20 and 49 years of age. The anterior mediastinum was the most frequently affected compartment (66 patients), followed by the upper mediastinum (18 patients), the posterior mediastinum (16 patients), and the middle mediastinum (14 patients). The most frequent histological types were: benign thymus diseases (N = 40), mesenchymal tumors (N = 17), lymphomas (N = 15), neural tumors (N = 9), and germ cell tumors (N = 8). Malignant tumors were more frequently symptomatic (91 percent), and benign tumors were more frequent in asymptomatic patients (92 percent). The most frequent symptoms were related to myastenia gravis, followed by dyspnea and chest pain. Weight loss, anorexia and fever were significantly more frequent in patients with malignant neoplasias. Conclusions: Regarding the clinical aspects we can state that benign lesions were predominant, that mediastinal diseases were more prevalent in young adults, and that benign lesions were more frequent in asymptomatic patients. Treatment (clinical/surgical) was effective in most patients, benefiting approximately 90 percent of the patients with benign affections and 45 percent of the patients with malignant tumors. In 73 percent of the benign affections, surgical treatment was capable of achieving the cure. Mortality resulting from complications was 1.75 percent.

Mediastinal widening in a patient of ulcerative colitis.

A case of ulcertaive colitis on long-term corticosteroid therapy presenting with mediastinal widening and diagnosed to have mediastinal lipomatosis an thoracic computed tomography is presented.

Spontaneous oesophageal perforation due to mediastinal tuberculous lymphadenitis - atypical presentation of tuberculosis.

Spontaneous non-traumatic oesophageal perforation secondary to bursting of a mediastinal tuberculous abscess into the oesophagus is rare. The diagnosis is delayed, as perforation remains localised due to mediastinal lymph nodes. Patient can be effectively managed by paraoesophageal drainage of the mediastinal abscess and oesophageal diversion.

Primary mediastinal hydatid cyst.

An unusual case of primary mediastinal echinococcosis in a young female presented with non-specific symptoms. On examination, she had signs of Horner's syndrome and mild superior vena cava compression. She was operated successfully. The final diagnosis could only be made on the operating table and confirmed by histopathology. Hydatid cyst in mediastinum is uncommon but because of surrounding vital structures and potential of its complete cure should be explored without delay.

Dysphagia due to mediastinal tuberculous lymphadenitis presenting as an esophageal submucosal tumor: a case report

Mediastinal tuberculous lymphadenitis is rare in adults, and it is even rarer for dysphagia to be the presenting symptom of mediastinal tuberculous lymphadenitis. Mediastinal tuberculous lymphadenitis with esophageal symptoms has been presented as esophageal ulceration, mucosal or submucosal mass with ulceration, fistula or sinus formation, extrinsic compression, or displacement of the esophagus. An exaggerated form of extrinsic compression may be presented as a submucosal tumor, radiologically or endoscopically. A barium esophagography of a 34 year-old woman with painful dysphagia revealed a large submucosal tumor-like mass on the mid-esophagus. The symptom was spontaneously improved over a 3-week period together with reduction of the mass size. A computed tomography of the chest disclosed an enlarged subcarinal lymph node and histologic examination of the specimen obtained by thoracoscopic biopsy brought about a diagnosis of tuberculosis. We herein report a case of mediastinal tuberculosis with unusual manifestations.

Esophageal duplication cyst complicated with intramural hematoma: case report

Esophageal duplication cysts account for a very small percentage of benign esophageal tumors and are infrequently symptomatic. Esophageal duplication cysts result from aberrant alignment of the normal vacuolization process that produce the esophageal lumen in the 5th to 8th week of embryonic life. Complications most often are bleeding into or infection of cysts. Recently, we experienced a case of esophageal duplication cyst complicated with intramural huge hematoma and the cause of hematoma could not be identified. We report it with a review of literatures.

Hematoma mediastinal causante de severa compresión de la vía aérea / Mediastinal hematoma causing severe airway compression

Presentamos el caso de una paciente de 43 años que ingresó al Centro Respiratorio por presentar un cuadro de asma grave, anemia severa y acidosis metabólica. Durante la ARM se detectó una masa mediastinal que comprimía la tráquea y que en la tomografía computada tenía densidad de tejidos sólidos. Previamente se había colocado un catéter central por punción de la vena yugular interna. La paciente falleció y en la autopsia se evidenció un hematoma mediastinal compresivo que se atribuyó a la punción. Se destacan el error diagnóstico cometido, por las características tomográficas del hematoma, y la génesis de una causa infrecuente de obstrucción de la vía aérea como complicación de un procedimiento cuya peligrosidad no fue adecuadamente valorada en relación a los trastornos de coagulación pre-existentes