Clinical Spectrum of Mediastinal Cysts: Surgical Treatment
Overall, 38 patients (36.2%) with mediastinal cysts were symptomatic: 39.2% of bronchogenic/esophageal foregut cysts, 40% of thymic cysts, and 15.8% of pericardial/pleural cysts. These symptoms usually appeared in progressive fashion in most patients. Overall common symptoms were retrosternal chest pain (14.3%), followed by dyspnea (7.6%), cough (6.7%), fever (5.7%), and hoarseness (4.8%). Of particular interest, 4 of 30 patients with benign thymic cysts presented with hoarseness despite the benign nature of this disease. Two patients with meningoceles in the posterior mediastinum were associated with cutaneous neurofibromatosis (von Recklinghausen disease). We also found acute symptoms of fever and chest pain due to abrupt enlargement and rupturing into the mediastinum in one patient with an esophageal duplication cyst. One patient with a thoracic duct cyst was referred to us with recurrent retrosternal chest pain. A 6-month-old boy with a huge pleural cyst was transferred to our clinic with severe respiratory distress and cyanosis, and an emergency operation was performed (Fig 4). Surgical excision eliminated these symptoms, including vocal cord paralysis. canadian family pharmacy online
In these diseases, surgical excision is definitely diagnostic and therapeutic. Surgical removal was performed via an axillary thoracotomy or median sternotomy, which was chosen with regard to the tumor size, location, and extension in the early series, Since 1993, when video-assisted thoracic surgery (VATS) was introduced, 19 of 28 patients with mediastinal cysts received VATS resection in the current study for up to 12 cm in size of thymic cyst. Though the cysts were often histologically benign, they may present difficult surgical problems because of the vital structures involved.
Figure 4. Preoperative chest radiograph of a 6-month-old with a huge pleural cyst (top). Postoperative course was quite uneventful (bottom).