In the new era of functional magnetic resonance imaging(MRI), the utility of chest MRI is increasing exponentially due to several advances, including absence of ionizing radiation, excellent tissue contrast and high c...In the new era of functional magnetic resonance imaging(MRI), the utility of chest MRI is increasing exponentially due to several advances, including absence of ionizing radiation, excellent tissue contrast and high capability for lesion characterization and treatment monitoring. The application of several of these diagnostic weapons in a multiparametric fashion enables to better characterize thymic epithelial tumors and other mediastinal tumoral lesions, accurate assessment of the invasion of adjacent structures and detection of pathologic lymph nodes and metastasis. Also, "do not touch lesions" could be identified with the associated impact in the management of those patients. One of the hotspots of the multiparametric chest MR is its ability to detect with acuity early response to treatment in patients with mediastinal malignant neoplasms. This has been related with higher rates of overall survival and progression free survival.Therefore, in this review we will analyze the current functional imaging techniques available(18 F-Fluorodeoxiglucose positron emission tomography/computed tomography, diffusion-weighted imaging, dynamic contrast-enhanced MRI, diffusion tensor imaging and MR spectroscopy) for the evaluation of mediastinal lesions, with a focus in their correct acquisition and post-processing. Also, to review the clinical applications of these techniques in the diagnostic approach of benign and malignant conditions of the mediastinum.展开更多
BACKGROUND Pleomorphic lipoma (PL) is a rare benign mesenchymal tumor occurring predominantly in middle-aged and elderly men. It is typically found in the subcutaneous tissue of the posterior neck, back, and shoulders...BACKGROUND Pleomorphic lipoma (PL) is a rare benign mesenchymal tumor occurring predominantly in middle-aged and elderly men. It is typically found in the subcutaneous tissue of the posterior neck, back, and shoulders. There have also been a few reported cases in the face, scalp, and upper extremities. Currently, there is no report on its occurrence in the anterior mediastinum. CASE SUMMARY Herein, we report the case of a 67-year-old woman diagnosed with PL in the anterior mediastinum. The tumor was removed by thoracoscopic surgery. There was no recurrence during the 24-mo follow-up period, and the prognosis was good. Most PL are located on the skin surface. However, they may also occur within the body, even in the mediastinum. CONCLUSION PL occurring in the anterior mediastinum is rare, and it may be differentiated from other tumors.展开更多
Transcervical approach for tumors of the posterior mediastinum is traditionally thought not to be indicated. Hereby we report on a case of a patient with a huge neurogenic tumor of the posterior mediastinum which was ...Transcervical approach for tumors of the posterior mediastinum is traditionally thought not to be indicated. Hereby we report on a case of a patient with a huge neurogenic tumor of the posterior mediastinum which was successfully excised through a transcervical extended approach and, additionally, the variety of surgical approaches used to remove tumors of the posterior mediastinum is discussed. The new refined techniques of transcervical extended mediastinal operations, which are recently gaining popularity among surgeons, allowed for a safe dissection of the tumor, thus patient could benefit from a short painless postoperative course. The authors suggest that surgeons trained in these particular techniques should consider the choice of the transcervical extended access in selected cases of benign tumors of the posterior mediastinum.展开更多
BACKGROUND Calcifying fibrous tumor (CFT) is a rare benign mesenchymal tumor that often occurs in deep soft tissue of children and young adults.CFT rarely occurs in the mediastinum.CASE SUMMARY In this paper,we descri...BACKGROUND Calcifying fibrous tumor (CFT) is a rare benign mesenchymal tumor that often occurs in deep soft tissue of children and young adults.CFT rarely occurs in the mediastinum.CASE SUMMARY In this paper,we describe a 31-year-old male patient with CFT in the mediastinum.The patient did not have any symptoms,and the posterior mediastinal lesion was unintentionally found during routine re-examination of thyroid cancer.The tumor had no adhesion to the surrounding tissue and was successfully and completely removed.Pathology showed a large amount of collagen-rich fibrous connective tissue.There was scattered dystrophic calcification and gravel in the fibrous tissue and a small amount of lymphocyte and plasma cell infiltration and lymphoid follicle formation in the interstitial fluid.In addition,findings showed 20 IgG4+ plasma cells per high-powered field of the diseased tissue,an IgG4+/IgG ratio of about 20%,and normal serum IgG4 levels.The final diagnosis was CFT of the mediastinum (CFTM).No evidence of tumor recurrence was observed by computed tomography at 3 mo after surgery.CONCLUSION IgG4+ plasma cell enlargement may occur in CFTM,but clinical manifestations and serological tests suggest that it is not IgG4-related disease.We speculate that it may be an independent tumor subtype.展开更多
BACKGROUND In Japan,the transhiatal approach,including lower mediastinal lymph node dissection,is widely performed for Siewert type II esophagogastric junction adenocarcinoma.This procedure is generally performed in a...BACKGROUND In Japan,the transhiatal approach,including lower mediastinal lymph node dissection,is widely performed for Siewert type II esophagogastric junction adenocarcinoma.This procedure is generally performed in a magnified view using laparoscopy or a robotic system,therefore,the microanatomy of the lower mediastinum is important.However,mediastinal microanatomy is still unclear and classification of lower mediastinal lymph nodes is not currently based on fascia or other microanatomical structures.AIM To clarify the fascia and layer structures of the lower mediastinum and classify the lower mediastinal tissue.METHODS We dissected the esophagus and surrounding organs en-bloc from seven cadavers fixed in 10%formalin.Organs and tissues were then cut at the level of the lower thoracic esophagus,embedded in paraffin,and serially sectioned.Tissue sections were stained with Hematoxylin-Eosin(all cadavers)and immunostained for the lymphatic endothelial marker D2-40(three cadavers).We observed the periesophageal fasciae and layers,and defined lymph node boundaries based on the fasciae.Lymphatic vessels around the esophagus were observed on immunostained tissue sections.RESULTS We identified two fasciae,A and B.We then classified lower mediastinal tissue into three areas,paraesophageal,paraaortic,and intermediate,using these fasciae as boundaries.Lymph nodes were found to be present and were counted in each area.The dorsal part of the intermediate area was thicker on the caudal side than on the cranial side in all cadavers.On the dorsal side,no blood vessels penetrated the fasciae in six of the seven cadavers,whereas the proper esophageal artery penetrated fascia B in one cadaver.D2-40 immunostaining showed lymphatic vessel connections between the paraesophageal and intermediate areas on the lateral and ventral sides of the esophagus,but no lymphatic connection between areas on the dorsal side of the esophagus.CONCLUSION Histological studies identified two fasciae surrounding the esophagus in the lower mediastinum and the layers separated by these fasciae were used to classify the lower mediastinal tissues.展开更多
Cystic lymphangioma of the mediastinum (CLM) is extremely rare, usually a lot of the patients were found to have the disease by accident in adulthood.It is difficult to be diagnosed but surgery.We have received and tr...Cystic lymphangioma of the mediastinum (CLM) is extremely rare, usually a lot of the patients were found to have the disease by accident in adulthood.It is difficult to be diagnosed but surgery.We have received and treated a case and the diagnosis and therapy are worth discussing.展开更多
We treated a patient with inflammatory pseudotumor of the mediastinum that exhibited high uptake of fluorodeoxyglucose on positron emission tomography. A 69-year-old male patient was diagnosed with a mass measuring 70...We treated a patient with inflammatory pseudotumor of the mediastinum that exhibited high uptake of fluorodeoxyglucose on positron emission tomography. A 69-year-old male patient was diagnosed with a mass measuring 70 mm in diameter in the anterior mediastinum as revealed by computed tomography. The lesion showed strong uptake of 18-fluorine fluorodeoxyglucose with a maximum standardized uptake value of 10.24 on positron emission tomography, which was suggestive of a thymic malignancy. Complete resection of the mass was achieved, and the postoperative pathological examination confirmed an inflammatory pseudotumor of the mediastinum arising in a perithymic lymph node. Despite its rarity, inflammatory pseudotumor should be taken into consideration when diagnosing a mass lesion with characteristics suggestive of thymic neoplasm on fluorodeoxyglucose positron emission tomography-computed tomography.展开更多
Mediastinal thoracic duct cyst is a rare benign cystic disease. The lesion is generally in the post-erior or superior mediastinum, where the thoracic duct passes. We herein report an extremely rare case of surgically ...Mediastinal thoracic duct cyst is a rare benign cystic disease. The lesion is generally in the post-erior or superior mediastinum, where the thoracic duct passes. We herein report an extremely rare case of surgically resected anterior mediastinal thoracic duct cyst. A thoracic duct cyst should be considered as an uncommon differential diagnosis of an anterior mediastinal lesion.展开更多
Background: The mediastinum is a complex anatomical region which contains many vital structures. Many aspects of mediastinal surgery, like that for other anatomic regions, have evolved from a maximally invasive approa...Background: The mediastinum is a complex anatomical region which contains many vital structures. Many aspects of mediastinal surgery, like that for other anatomic regions, have evolved from a maximally invasive approach involving a median sternotomy, anterior mediastinotomy, mediastinoscopy or thoracotomy, to a minimally invasive video-assisted approach. Robotic surgery is presently the most advanced form of minimally invasive surgery. Methods: We reviewed our experience with a robotic approach to mediastinal pathology. In addition, an extensive search was conducted using PubMed, in order to extract references for the application of robotics to surgical conditions of the mediastinum. Results: The first robotic procedure by our group was a mediastinal procedure in 2003. In the past eighteen years, 203 patients have undergone robotic surgery for mediastinal pathology. There were 119 procedures for the Anterior Mediastinum, 33 procedures for the Middle Mediastinum, and 51 procedures for the Posterior Mediastinum. 78 patients underwent robotic thymectomy using a left-sided approach. 43/78 (55%) patients underwent radical thymectomy for Myasthenia Gravis. Thymoma was histologically identified in 32% of patients with Myasthenia Gravis. In patients with thymoma, there was no tumor recurrence. In patients with Myasthenia Gravis, the overall improvement rate after robotic radical complete thymectomy was 91% (39/43). Following robotic surgery for the mediastinal disease, the median hospitalization was 3 days, major complications occurred in 0.9% of patients and there was no mortality. Conclusion: With the advent of robotic surgery, many of the current surgical approaches to diseases of the mediastinum will likely be replaced over time by robotic surgery. When applied to the mediastinum, robotics has a number of benefits when compared to conventional Video-Assisted Thoracic Surgery (VATS) including three-dimensional visualization, magnification of the operative field, precise instrument movement, and improved dexterity. Much of the mediastinal disease encountered in an adult is benign, making it especially suited to a minimally invasive approach. With the use of the robot, a complete anatomical and oncological procedure can be performed through a number of small incisions or ports, while at the same time providing the patient with minimally invasive benefits including shorter hospitalizations, quicker returns to preoperative activity, less pain, less inflammatory response and better cosmesis. The excellent range of motion of the robotic instruments makes them particularly suitable to maneuver around the vital structures and the rigid axial skeleton encountered in various compartments of the mediastinum, and for reaching those “distant” areas of the mediastinum that are difficult to explore and dissect with conventional Video-Assisted Thoracic Surgery (VATS).展开更多
Aim: To report a rare case of Spontaneous subcutaneous emphysema and pneumo-mediastinum Introduction: Spontaneous subcutaneous emphysema and pneumo-mediastinum may be defined as the presence of free gas or air in the ...Aim: To report a rare case of Spontaneous subcutaneous emphysema and pneumo-mediastinum Introduction: Spontaneous subcutaneous emphysema and pneumo-mediastinum may be defined as the presence of free gas or air in the subcutaneous tissue or mediastinal structures without an apparent precipitating cause. It most commonly occurs in adolescent in good physical health group devoid of severe existing lung pathology. Case Report: In our case, a middle aged married housewife was referred to Department of Medicine, Peoples Medical University Hospital Nawabshah, Sindh, Pakistan, by her local GP for the worsening of her condition due to development of acute neck pain, difficulty in breathing, eating and swallowing (mainly for solid foods) with swelling of neck. She was not complaining of any respiratory symptoms. The chest and neck radiographs showed subcutaneous emphysema and pneumo-mediastinum, there was no any evidence of air leakage from esophagus. She was subsequently put on free fluids, light diet, antibiotics, analgesia and other supportive measures along with close observation. After three days of admission, her clinical symptoms were alleviated to a great extent. She was discharged well from hospital after four days. Conclusion: Spontaneous subcutaneous emphysema with pneumo-mediastinum is medical and surgical emergency. Diagnosis may be made by routine chest X-rays and CT scan of the chest. Prompt diagnosis and immediate management may affect the morbidity and mortality outcomes in this condition.展开更多
We present a rare and unusual complication of cervico-facial soft tissue emphysema with pneumo-mediastinum which occurred in a 30-year-old female Jordanian patient in our hospital in October 2010 in Abu Dhabi followin...We present a rare and unusual complication of cervico-facial soft tissue emphysema with pneumo-mediastinum which occurred in a 30-year-old female Jordanian patient in our hospital in October 2010 in Abu Dhabi following FESS. CT scan evaluation of aero-digestive tract in the immediate post-operative period was done to ascertain the cause pertaining to any surgical trauma or anaesthesia related complications. Such a case previously unreported has been included in this study. A simple close monitoring after establishing the cause is usually sufficient in management of such related or unrelated complications during FESS which in our case was likely to be anaesthesia related. Published data of such a complication assists in building up a good and effective medical audit based on ethical practice. This paper stresses the importance of immediate CT scan of aero-digestive tract in evaluating the cause.展开更多
209550 The management of giant mediastinal lymph node hyperplasia:report of 20 cases/Ye Bo(叶波,Dept Thorac Surg,Cancer Hosp,Chin Acad Med Sci Peking Union Med Col,Beijing 100021)…∥Chin J Thorac Cardio-vasc Surg. -2...209550 The management of giant mediastinal lymph node hyperplasia:report of 20 cases/Ye Bo(叶波,Dept Thorac Surg,Cancer Hosp,Chin Acad Med Sci Peking Union Med Col,Beijing 100021)…∥Chin J Thorac Cardio-vasc Surg. -2009,25(4). -248展开更多
Background Middle mediastinal masses comprise a wide variety of tumors but may also reflect lymphadenopathy, and thus remain an interesting diagnostic challenge. We performed positron emission tomography （PET） of me...Background Middle mediastinal masses comprise a wide variety of tumors but may also reflect lymphadenopathy, and thus remain an interesting diagnostic challenge. We performed positron emission tomography （PET） of mediastinal masses in order to evaluate the ability of PET to predict the malignancy of these tumors. We compared histologic findings, videomediastinoscopy, computed tomography （CT）, and PET-CT in patients with mediastinal disease. Methods Thirty-two patients were evaluated with CT, PET-CT and videomediastionoscopy, and all studies were performed within four weeks in each patient. ^11C-choline as a PET tracer was used to visualize masses. PET data were evaluated using the standardized uptake value （SUV） and were compared with pathologic data. Results There were 13 men and 19 women aged from 21 to 74 （mean 45.2） years. Among the patients with mediastinal diseases, sarcoidosis was diagnosed in 12 patients, tuberculosis in 5 patients, lymphoma in 5 patients, and noncaseating granulomata without classical ＂sarcoid＂ finding in 3 patients. N2 or N3 nodal metastasis was revealed in 6 of 7 patients who had non-small cell lung cancer or suspected lung cancer, and one was negative （the pathological diagnosis was reactive hyperplasia）. The accuracies for correctly diagnosing mediastinal masses for CT, PET-CT and videomediastinoscopy were 38% （12/32）, 63% （20/32）, and 91% （29/32） respectively. The diagnostic accuracy of videomediastinoscopy was superior to that of PET-CT （X^2=11.130, P〈0.001）. The SUVs were similar among these diseases. On the other hand, if the diagnostic classification was benign vs malignancy, the accuracies for CT, PET-CT and videomediastinoscopy were 53% （17/32）, 75% （24/32）, 100% （32/32） respectively. The diagnostic accuracy of videomediastinoscopy was superior to that of PET-CT （X^2=22.042, P〈0.001）. The SUV of malignant lesions （6.9, 3.2-9.8; n=11） appeared to be higher than that of benign lesions （4.9, 2.9-8.3; n=21）, however, this difference was not statistically significant （P=0.054）. Conclusions To diagnose lesions located in the middle mediastinum, videomediastinoscopy possesses the highest diagnostic accuracy, and therefore remains the gold standard. PET-CT is valuable for differential diagnosis of benign vs malignant lesions, CT alone or PET alone （SUV） may provide misdiagnosis in a substantial proportion of patients with mediastinal masses.展开更多
INTRODUCTION Ectopically located hyperfunctioning parathyroid gland（s） are responsible for approximately 6-16% ofhyperparathyroidism cases, in which about 6% can be ascribed to ectopic growth in the mediastinal site...INTRODUCTION Ectopically located hyperfunctioning parathyroid gland（s） are responsible for approximately 6-16% ofhyperparathyroidism cases, in which about 6% can be ascribed to ectopic growth in the mediastinal site. Treatment ofectopic adenomas usually requires resection. There are various techniques to resect ectopic parathyroid glands, which are mainly depended on the ectopic gland＇s location. However, choosing the correct type of treatment for cases can be difficult since there are no commonly accepted guidelines for treatment selection.展开更多
BACKGROUND Liposarcoma is the most common soft tissue tumor in adults.Liposarcoma commonly occurs in the lower extremities and retroperitoneum but rarely in the mediastinum.To the best of our knowledge,this is the fir...BACKGROUND Liposarcoma is the most common soft tissue tumor in adults.Liposarcoma commonly occurs in the lower extremities and retroperitoneum but rarely in the mediastinum.To the best of our knowledge,this is the first report of bilateral single-port video-assisted thoracoscopic surgery(VATS)for giant mediastinal liposarcoma and the first report of esophageal fistula after this surgery.CASE SUMMARY We present the case of a 71-year-old male patient with a giant posterior mediastinal tumor.Chest computed tomography and magnetic resonance imaging showed that the tumor completely involved the esophagus.The patient underwent bilateral single-port VATS and the tumor was completely removed.An esophageal fistula was detected 9 days after surgery and 2 days after eating.Emergency debridement surgery was performed,and a drainage tube was placed.The fistula healed gradually after the second surgery.CONCLUSION VATS is safer than thoracotomy for treating giant mediastinal liposarcoma.For tumors extensively involving the esophagus,preventive measures against esophageal fistula are necessary.展开更多
文摘In the new era of functional magnetic resonance imaging(MRI), the utility of chest MRI is increasing exponentially due to several advances, including absence of ionizing radiation, excellent tissue contrast and high capability for lesion characterization and treatment monitoring. The application of several of these diagnostic weapons in a multiparametric fashion enables to better characterize thymic epithelial tumors and other mediastinal tumoral lesions, accurate assessment of the invasion of adjacent structures and detection of pathologic lymph nodes and metastasis. Also, "do not touch lesions" could be identified with the associated impact in the management of those patients. One of the hotspots of the multiparametric chest MR is its ability to detect with acuity early response to treatment in patients with mediastinal malignant neoplasms. This has been related with higher rates of overall survival and progression free survival.Therefore, in this review we will analyze the current functional imaging techniques available(18 F-Fluorodeoxiglucose positron emission tomography/computed tomography, diffusion-weighted imaging, dynamic contrast-enhanced MRI, diffusion tensor imaging and MR spectroscopy) for the evaluation of mediastinal lesions, with a focus in their correct acquisition and post-processing. Also, to review the clinical applications of these techniques in the diagnostic approach of benign and malignant conditions of the mediastinum.
文摘BACKGROUND Pleomorphic lipoma (PL) is a rare benign mesenchymal tumor occurring predominantly in middle-aged and elderly men. It is typically found in the subcutaneous tissue of the posterior neck, back, and shoulders. There have also been a few reported cases in the face, scalp, and upper extremities. Currently, there is no report on its occurrence in the anterior mediastinum. CASE SUMMARY Herein, we report the case of a 67-year-old woman diagnosed with PL in the anterior mediastinum. The tumor was removed by thoracoscopic surgery. There was no recurrence during the 24-mo follow-up period, and the prognosis was good. Most PL are located on the skin surface. However, they may also occur within the body, even in the mediastinum. CONCLUSION PL occurring in the anterior mediastinum is rare, and it may be differentiated from other tumors.
文摘Transcervical approach for tumors of the posterior mediastinum is traditionally thought not to be indicated. Hereby we report on a case of a patient with a huge neurogenic tumor of the posterior mediastinum which was successfully excised through a transcervical extended approach and, additionally, the variety of surgical approaches used to remove tumors of the posterior mediastinum is discussed. The new refined techniques of transcervical extended mediastinal operations, which are recently gaining popularity among surgeons, allowed for a safe dissection of the tumor, thus patient could benefit from a short painless postoperative course. The authors suggest that surgeons trained in these particular techniques should consider the choice of the transcervical extended access in selected cases of benign tumors of the posterior mediastinum.
基金Supported by Natural Science Foundation of Liaoning Province in China,No.81572621 and No.2019-MS-370
文摘BACKGROUND Calcifying fibrous tumor (CFT) is a rare benign mesenchymal tumor that often occurs in deep soft tissue of children and young adults.CFT rarely occurs in the mediastinum.CASE SUMMARY In this paper,we describe a 31-year-old male patient with CFT in the mediastinum.The patient did not have any symptoms,and the posterior mediastinal lesion was unintentionally found during routine re-examination of thyroid cancer.The tumor had no adhesion to the surrounding tissue and was successfully and completely removed.Pathology showed a large amount of collagen-rich fibrous connective tissue.There was scattered dystrophic calcification and gravel in the fibrous tissue and a small amount of lymphocyte and plasma cell infiltration and lymphoid follicle formation in the interstitial fluid.In addition,findings showed 20 IgG4+ plasma cells per high-powered field of the diseased tissue,an IgG4+/IgG ratio of about 20%,and normal serum IgG4 levels.The final diagnosis was CFT of the mediastinum (CFTM).No evidence of tumor recurrence was observed by computed tomography at 3 mo after surgery.CONCLUSION IgG4+ plasma cell enlargement may occur in CFTM,but clinical manifestations and serological tests suggest that it is not IgG4-related disease.We speculate that it may be an independent tumor subtype.
文摘BACKGROUND In Japan,the transhiatal approach,including lower mediastinal lymph node dissection,is widely performed for Siewert type II esophagogastric junction adenocarcinoma.This procedure is generally performed in a magnified view using laparoscopy or a robotic system,therefore,the microanatomy of the lower mediastinum is important.However,mediastinal microanatomy is still unclear and classification of lower mediastinal lymph nodes is not currently based on fascia or other microanatomical structures.AIM To clarify the fascia and layer structures of the lower mediastinum and classify the lower mediastinal tissue.METHODS We dissected the esophagus and surrounding organs en-bloc from seven cadavers fixed in 10%formalin.Organs and tissues were then cut at the level of the lower thoracic esophagus,embedded in paraffin,and serially sectioned.Tissue sections were stained with Hematoxylin-Eosin(all cadavers)and immunostained for the lymphatic endothelial marker D2-40(three cadavers).We observed the periesophageal fasciae and layers,and defined lymph node boundaries based on the fasciae.Lymphatic vessels around the esophagus were observed on immunostained tissue sections.RESULTS We identified two fasciae,A and B.We then classified lower mediastinal tissue into three areas,paraesophageal,paraaortic,and intermediate,using these fasciae as boundaries.Lymph nodes were found to be present and were counted in each area.The dorsal part of the intermediate area was thicker on the caudal side than on the cranial side in all cadavers.On the dorsal side,no blood vessels penetrated the fasciae in six of the seven cadavers,whereas the proper esophageal artery penetrated fascia B in one cadaver.D2-40 immunostaining showed lymphatic vessel connections between the paraesophageal and intermediate areas on the lateral and ventral sides of the esophagus,but no lymphatic connection between areas on the dorsal side of the esophagus.CONCLUSION Histological studies identified two fasciae surrounding the esophagus in the lower mediastinum and the layers separated by these fasciae were used to classify the lower mediastinal tissues.
文摘Cystic lymphangioma of the mediastinum (CLM) is extremely rare, usually a lot of the patients were found to have the disease by accident in adulthood.It is difficult to be diagnosed but surgery.We have received and treated a case and the diagnosis and therapy are worth discussing.
文摘We treated a patient with inflammatory pseudotumor of the mediastinum that exhibited high uptake of fluorodeoxyglucose on positron emission tomography. A 69-year-old male patient was diagnosed with a mass measuring 70 mm in diameter in the anterior mediastinum as revealed by computed tomography. The lesion showed strong uptake of 18-fluorine fluorodeoxyglucose with a maximum standardized uptake value of 10.24 on positron emission tomography, which was suggestive of a thymic malignancy. Complete resection of the mass was achieved, and the postoperative pathological examination confirmed an inflammatory pseudotumor of the mediastinum arising in a perithymic lymph node. Despite its rarity, inflammatory pseudotumor should be taken into consideration when diagnosing a mass lesion with characteristics suggestive of thymic neoplasm on fluorodeoxyglucose positron emission tomography-computed tomography.
文摘Mediastinal thoracic duct cyst is a rare benign cystic disease. The lesion is generally in the post-erior or superior mediastinum, where the thoracic duct passes. We herein report an extremely rare case of surgically resected anterior mediastinal thoracic duct cyst. A thoracic duct cyst should be considered as an uncommon differential diagnosis of an anterior mediastinal lesion.
文摘Background: The mediastinum is a complex anatomical region which contains many vital structures. Many aspects of mediastinal surgery, like that for other anatomic regions, have evolved from a maximally invasive approach involving a median sternotomy, anterior mediastinotomy, mediastinoscopy or thoracotomy, to a minimally invasive video-assisted approach. Robotic surgery is presently the most advanced form of minimally invasive surgery. Methods: We reviewed our experience with a robotic approach to mediastinal pathology. In addition, an extensive search was conducted using PubMed, in order to extract references for the application of robotics to surgical conditions of the mediastinum. Results: The first robotic procedure by our group was a mediastinal procedure in 2003. In the past eighteen years, 203 patients have undergone robotic surgery for mediastinal pathology. There were 119 procedures for the Anterior Mediastinum, 33 procedures for the Middle Mediastinum, and 51 procedures for the Posterior Mediastinum. 78 patients underwent robotic thymectomy using a left-sided approach. 43/78 (55%) patients underwent radical thymectomy for Myasthenia Gravis. Thymoma was histologically identified in 32% of patients with Myasthenia Gravis. In patients with thymoma, there was no tumor recurrence. In patients with Myasthenia Gravis, the overall improvement rate after robotic radical complete thymectomy was 91% (39/43). Following robotic surgery for the mediastinal disease, the median hospitalization was 3 days, major complications occurred in 0.9% of patients and there was no mortality. Conclusion: With the advent of robotic surgery, many of the current surgical approaches to diseases of the mediastinum will likely be replaced over time by robotic surgery. When applied to the mediastinum, robotics has a number of benefits when compared to conventional Video-Assisted Thoracic Surgery (VATS) including three-dimensional visualization, magnification of the operative field, precise instrument movement, and improved dexterity. Much of the mediastinal disease encountered in an adult is benign, making it especially suited to a minimally invasive approach. With the use of the robot, a complete anatomical and oncological procedure can be performed through a number of small incisions or ports, while at the same time providing the patient with minimally invasive benefits including shorter hospitalizations, quicker returns to preoperative activity, less pain, less inflammatory response and better cosmesis. The excellent range of motion of the robotic instruments makes them particularly suitable to maneuver around the vital structures and the rigid axial skeleton encountered in various compartments of the mediastinum, and for reaching those “distant” areas of the mediastinum that are difficult to explore and dissect with conventional Video-Assisted Thoracic Surgery (VATS).
文摘Aim: To report a rare case of Spontaneous subcutaneous emphysema and pneumo-mediastinum Introduction: Spontaneous subcutaneous emphysema and pneumo-mediastinum may be defined as the presence of free gas or air in the subcutaneous tissue or mediastinal structures without an apparent precipitating cause. It most commonly occurs in adolescent in good physical health group devoid of severe existing lung pathology. Case Report: In our case, a middle aged married housewife was referred to Department of Medicine, Peoples Medical University Hospital Nawabshah, Sindh, Pakistan, by her local GP for the worsening of her condition due to development of acute neck pain, difficulty in breathing, eating and swallowing (mainly for solid foods) with swelling of neck. She was not complaining of any respiratory symptoms. The chest and neck radiographs showed subcutaneous emphysema and pneumo-mediastinum, there was no any evidence of air leakage from esophagus. She was subsequently put on free fluids, light diet, antibiotics, analgesia and other supportive measures along with close observation. After three days of admission, her clinical symptoms were alleviated to a great extent. She was discharged well from hospital after four days. Conclusion: Spontaneous subcutaneous emphysema with pneumo-mediastinum is medical and surgical emergency. Diagnosis may be made by routine chest X-rays and CT scan of the chest. Prompt diagnosis and immediate management may affect the morbidity and mortality outcomes in this condition.
文摘We present a rare and unusual complication of cervico-facial soft tissue emphysema with pneumo-mediastinum which occurred in a 30-year-old female Jordanian patient in our hospital in October 2010 in Abu Dhabi following FESS. CT scan evaluation of aero-digestive tract in the immediate post-operative period was done to ascertain the cause pertaining to any surgical trauma or anaesthesia related complications. Such a case previously unreported has been included in this study. A simple close monitoring after establishing the cause is usually sufficient in management of such related or unrelated complications during FESS which in our case was likely to be anaesthesia related. Published data of such a complication assists in building up a good and effective medical audit based on ethical practice. This paper stresses the importance of immediate CT scan of aero-digestive tract in evaluating the cause.
文摘209550 The management of giant mediastinal lymph node hyperplasia:report of 20 cases/Ye Bo(叶波,Dept Thorac Surg,Cancer Hosp,Chin Acad Med Sci Peking Union Med Col,Beijing 100021)…∥Chin J Thorac Cardio-vasc Surg. -2009,25(4). -248
基金This study was supported by a grant from Shangdong Provincial Ministry of Science and Technology (No. 2004BS03018).
文摘Background Middle mediastinal masses comprise a wide variety of tumors but may also reflect lymphadenopathy, and thus remain an interesting diagnostic challenge. We performed positron emission tomography （PET） of mediastinal masses in order to evaluate the ability of PET to predict the malignancy of these tumors. We compared histologic findings, videomediastinoscopy, computed tomography （CT）, and PET-CT in patients with mediastinal disease. Methods Thirty-two patients were evaluated with CT, PET-CT and videomediastionoscopy, and all studies were performed within four weeks in each patient. ^11C-choline as a PET tracer was used to visualize masses. PET data were evaluated using the standardized uptake value （SUV） and were compared with pathologic data. Results There were 13 men and 19 women aged from 21 to 74 （mean 45.2） years. Among the patients with mediastinal diseases, sarcoidosis was diagnosed in 12 patients, tuberculosis in 5 patients, lymphoma in 5 patients, and noncaseating granulomata without classical ＂sarcoid＂ finding in 3 patients. N2 or N3 nodal metastasis was revealed in 6 of 7 patients who had non-small cell lung cancer or suspected lung cancer, and one was negative （the pathological diagnosis was reactive hyperplasia）. The accuracies for correctly diagnosing mediastinal masses for CT, PET-CT and videomediastinoscopy were 38% （12/32）, 63% （20/32）, and 91% （29/32） respectively. The diagnostic accuracy of videomediastinoscopy was superior to that of PET-CT （X^2=11.130, P〈0.001）. The SUVs were similar among these diseases. On the other hand, if the diagnostic classification was benign vs malignancy, the accuracies for CT, PET-CT and videomediastinoscopy were 53% （17/32）, 75% （24/32）, 100% （32/32） respectively. The diagnostic accuracy of videomediastinoscopy was superior to that of PET-CT （X^2=22.042, P〈0.001）. The SUV of malignant lesions （6.9, 3.2-9.8; n=11） appeared to be higher than that of benign lesions （4.9, 2.9-8.3; n=21）, however, this difference was not statistically significant （P=0.054）. Conclusions To diagnose lesions located in the middle mediastinum, videomediastinoscopy possesses the highest diagnostic accuracy, and therefore remains the gold standard. PET-CT is valuable for differential diagnosis of benign vs malignant lesions, CT alone or PET alone （SUV） may provide misdiagnosis in a substantial proportion of patients with mediastinal masses.
文摘INTRODUCTION Ectopically located hyperfunctioning parathyroid gland（s） are responsible for approximately 6-16% ofhyperparathyroidism cases, in which about 6% can be ascribed to ectopic growth in the mediastinal site. Treatment ofectopic adenomas usually requires resection. There are various techniques to resect ectopic parathyroid glands, which are mainly depended on the ectopic gland＇s location. However, choosing the correct type of treatment for cases can be difficult since there are no commonly accepted guidelines for treatment selection.
文摘BACKGROUND Liposarcoma is the most common soft tissue tumor in adults.Liposarcoma commonly occurs in the lower extremities and retroperitoneum but rarely in the mediastinum.To the best of our knowledge,this is the first report of bilateral single-port video-assisted thoracoscopic surgery(VATS)for giant mediastinal liposarcoma and the first report of esophageal fistula after this surgery.CASE SUMMARY We present the case of a 71-year-old male patient with a giant posterior mediastinal tumor.Chest computed tomography and magnetic resonance imaging showed that the tumor completely involved the esophagus.The patient underwent bilateral single-port VATS and the tumor was completely removed.An esophageal fistula was detected 9 days after surgery and 2 days after eating.Emergency debridement surgery was performed,and a drainage tube was placed.The fistula healed gradually after the second surgery.CONCLUSION VATS is safer than thoracotomy for treating giant mediastinal liposarcoma.For tumors extensively involving the esophagus,preventive measures against esophageal fistula are necessary.
