Mediastinal parathyroid cysts (MPCs) are extremely rare, benign lesions arising from the parathyroid glands and residing within the thoracic cavity. This study aims to advance understanding of MPC, emphasizing accurate diagnosis and management approaches for this rare condition. A 46-year-old woman presented with dysphagia for one week. Blood tests revealed elevated parathyroid hormone (PTH) (112.8 pg/mL) and normal serum calcium (9.54 mg/dL). Ultrasonography identified a large, well-defined cystic nodule measuring 46 × 30 × 25 mm, extending retro-sternally in the right upper third of the chest. A subsequent high-resolution computed tomography scan of the chest revealed a large space-occupying lesion (47 × 43 × 31 mm) in the superior mediastinum, near the esophagus, suggesting an esophageal duplication cyst or, less likely, a bronchogenic cyst. Video-assisted thoracoscopic surgery (VATS) was performed, and the entire cyst was excised, confirmed histologically as a mediastinal parathyroid cyst. Mediastinal involvement of PCs poses diagnostic challenges due to their rarity and diverse clinical presentations. Surgical excision is necessary for symptomatic cases, with VATS emerging as a favorable approach.

Background: Bronchogenic cysts result from a congenital anomalous budding of the tracheobronchial tree. Resection is usually recommended to avoid complications. Mediastinal bronchogenic cysts present a unique challenge due to their proximity to vital structures. The purpose of this study is to review our experience with mediastinal bronchogenic cysts. Methods: A single-institution retrospective review evaluated all mediastinal bronchogenic cyst excisions between January 2012 and November 2022. Patient demographics were assessed, including age at diagnosis, presenting symptoms, imaging workup, and cyst characteristics. Operative approach, complications, and surgical pathology were reported. Results: Five patients were identified. Age at diagnosis ranged from 18 to 27 months. No patient was diagnosed prenatally. All patients had symptoms at the time of diagnosis, including cough, wheezing, and respiratory distress. Three cysts were paratracheal, and two were paraesophageal. Age at surgery ranged from 26 to 30 months. All bronchogenic cysts were successfully resected thoracoscopically. Individual technical challenges included narrowing of the mainstem bronchus preventing lung isolation, significant mediastinal inflammation, the necessity for cyst evacuation to delineate the extent of the cyst, adherence of cyst wall to bronchus or trachea requiring cold dissection, and a stalk of tissue with an intimate connection to the carina that was amputated. No intraoperative or postoperative complication occurred. Surgical pathology was consistent with a bronchogenic cyst in all cases. Median length of hospital stay was two days. Conclusion: Thoracoscopy is a safe and effective procedure for mediastinal bronchogenic cyst excision in children. Certain technical maneuvers are highlighted, which may facilitate resection.

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We report a very rare case of giant pericardial cyst with left ventricular compression on echocardiography. A 61-year-old man visited our hospital with a feeling of chest tightness. A cardiologist ruled out cardiac diseases of the patients and he was referred to us for examination and treatment of an abnormal left lung field shadow on chest x-ray. Chest computed tomography (CT) showed a 16×7.5 cm cystic mass in connect with the heart and diaphragm. Echocardiography showed that the cystic mass was compressing the left ventricle. Surgical resection was attempted by video-assisted thoracoscopic surgery (VATS). We aspirated serous liquid contents in the cyst and partially resected the cyst wall excepting cardiac side. After confirming the cyst was not a pericardial diverticulum, we completely resected its residual wall. His postoperative course was uncomplicated. The cyst was pathologically diagnosed as a pericardial cyst.

Multilocular thymic cysts (MTC) are acquired multilocular cysts caused by inflammation. The rarity of such lesions and a lack of recognition make diagnosis and treatment difficult. Herein, we present our experience with a multilocular mediastinal cyst that resulted in the development of thymic cancer with metastasis over a period of 13 years. Computed tomography findings revealed an anterior mediastinal mass that was suspected to be an MTC in a 49-year-old man. The mass shrank gradually over a period of 7 years; however, growth was observed at 10 years after initial detection. At 13 years after detection, thymic carcinoma with multiple lung metastases was diagnosed. Resection was recommended during the follow-up period, but the patient refused treatment. A multilocular wall and location are factors that indicate MTC. However, even if a definitive diagnosis is not made, resection of multilocular anterior mediastinal cysts should be considered as determining the preoperative diagnosis is difficult. Nevertheless, our case suggests that the coexistence of tumors with cysts is possible, and the potential for malignant tumor development exists.

BACKGROUND: Hydatid cysts are most frequently located in the liver and lungs and very rarely can be found in the pericardium. Diagnosis and treatment are quite challenging, as the disease can present itself in many forms depending to the location and the complications that it might cause.
METHODS: A 22-year-old man presented to our hospital with ongoing dry cough for more than 1 month prior to admission. Other symptoms included chest pain, fatigue, low grade fever, and night sweats, which have worsened in the past 2 weeks. Physical examination revealed normal respiratory and heart function. Chest X-ray demonstrated mediastinal enlargement and left pleural effusion. Contrast-enhanced computed tomography images showed a walled cystic mass lesion measuring up to 56 × 50 mm in close proximity to the upper left atrium, ascending aorta and pulmonary artery, potentially localized in the pericardium, with a 10 mm endoatrial filling defect, findings were compatible with hydatid cyst, left pleural effusion and peripheral pulmonary upper left lobe consolidation. Cardiac involvement was excluded on magnetic resonance imaging and trans-esophageal ultrasound. The patient underwent fine needle aspiration of the affected lung and thoracocentesis. No malignancy was found, meanwhile the biopsy confirmed the presence of pulmonary infarction. In view of the imaging findings were highly suspicious of a hydatid cyst, we performed a test of antibody titers that was negative. The patient underwent left anterolateral thoracotomy, and after the opening of the pericardium, a cystic mass of 5 cm in diameter was found next to the left atrium and in close proximity with the left pulmonary veins. The content of the cyst was completely removed after the surgical area was isolated with gauze impregnated with hypertonic solution (NaCl 10%). The mass resulted to be an echinococcal cyst with multiple daughter cysts within it that did not penetrate/involve (perforate) the cardiac wall.
CONCLUSIONS: Pericardial echinococcosis is a very rare pathology in which a high expertise multidisciplinary approach is required. The compression mass effect caused by the cyst can lead to complications, such as in our case where the pulmonary vein was compressed, leading to pulmonary infarction. The value of radiology studies and transoesophageal ultrasound are very important in the diagnosis. Surgery in these cases is always recommended, but preferred surgical approach is questionable. In cases such as ours, we recommend anterolateral thoracotomy.

The authors describe a case of a male neonate with split notochord syndrome presenting with cervico-thoracic deformity, thoracic neuroenteric cyst, separate abdominal duodenal duplication cyst and concurrent intestinal malrotation. This combination of abnormalities is very rare. When these lesions are suspected, patients must be investigated carefully.This case is presented not only to recount an infrequent combination of structural abnormalities but also to raise awareness of the signs that should point to clinical suspicion and prompt diagnosis.Following surgical excision of the thoracic neuroenteric cyst, the patient has made a good recovery.

BACKGROUND: Abnormalities in the development of the ventral foregut may result in bronchogenic cysts. Depending on the extent of aberrant budding, the location of a bronchogenic cyst might vary. The location and, more crucially, the size of the mass determine the onset of symptoms in individuals with bronchogenic cysts. Mediastinal bronchogenic cysts are mostly asymptomatic mediastinal masses discovered incidentally in adults. With the recent advancements in thoracoscopy, the removal can now be performed without the need for thoracotomies.
METHODS: We reported the case of incidental findings of an asymptomatic mediastinal bronchogenic cyst and opted for single-incision video-assisted thoracic surgery. The patient required no postoperative intensive care and discharged on third day after surgery with no complications.
CONCLUSIONS: Single-incision video-assisted thoracic surgery, also known as uniportal VATS, has swept the field of thoracic surgery in recent years, allowing us to execute challenging surgeries with a small single incision, avoiding the inherent morbidity of the standard open thoracotomy. We were able to remove mediastinal bronchogenic cysts using uniportal VATS completely. This method eliminates the need for post-operative critical care, reducing scarring and shortening hospital stays.
CONCLUSIONS: Bronchogenic cysts are uncommon mediastinal masses necessary for surgical therapy when discovered. The advancement of minimally invasive techniques offers surgeons safe new alternatives.

BACKGROUND: We describe 1 case of fetal giant pericardial cyst was diagnosed by fetal echocardiography in the second trimester, and the changes of the cyst were recorded by follow-up observation in the late trimester and after birth. We then review and discuss the knowledge about its diagnosis and treatment.
METHODS: A 34-year-old pregnant woman was referred to our hospital because of a diagnosis of a fetal pericardial effusion at 22 5/7 weeks at another hospital.
METHODS: Fetal echocardiography revealed an irregular anechoic area in the right side of the fetal right atrium and right ventricle that was closely related to but not communicated with the pericardiumis and suggested fetal pericardial cyst. Fetal cardiothoracic magnetic resonance imaging showed cystic FIESTA signal in the right lung region, with clear boundary, and a seemingly line-like low signal shadow within.
METHODS: Since fetal pericardial cysts keep decreasing in size during maternal pregnancy, follow-up observation measures are taken.
RESULTS: Fetal pericardial cysts disappear on their own 4 months after delivery.
CONCLUSIONS: Asymptomatic pericardial cysts in the fetal period can be followed up and observed, and intervention is performed only when the cyst rapidly enlarges or ruptures and becomes infected in the fetal or neonatal period. Echocardiography can be used as a first-line detection method for their initial detection and follow-up.

BACKGROUND: Pericardial cysts are a rare benign disorder with a variable clinical presentation depending on their size and location. The diagnosis of pericardial cysts is usually based on imaging examinations. The definitive treatment is surgical resection.
METHODS: A 36-year-old woman presented with progressive left-sided chest pain and exertional dyspnea, with symptoms resembling pleural effusion.
METHODS: The patient was diagnosed with a pericardial cyst based on imaging and video-assisted thoracoscopic surgery (VATS).
METHODS: VATS was performed.
RESULTS: The patient\'s symptoms improved after successful removal of the pericardial cyst. Follow-up chest computed tomography exhibited no evidence of recurrence.
CONCLUSIONS: Clinicians should include pericardial cysts in the differential diagnosis of pseudopleural effusion. VATS is a feasible and safe method to treat symptomatic and large pericardial cysts.