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Review
. 2005 Apr-Jun;9(2):142-8.

Mediastinoscopy in the treatment of mediastinal cysts

Sathyaprasad C Burjonrappa  1 , Raymond Taddeucci, Joseph Arcidi
Affiliations
Review

Mediastinoscopy in the treatment of mediastinal cysts

Sathyaprasad C Burjonrappa et al. JSLS. 2005 Apr-Jun.

Abstract

Objective: Primary cysts constitute 25% of all masses in the mediastinum. Because radiological investigations are often inconclusive, many adults require mediastinoscopy, thoracotomy, video-assisted thoracic surgery, or computed tomography-guided transbronchial, transesophageal, or transcutaneous aspiration to confirm the cystic nature of these lesions. Minimally invasive procedures fail when the cyst contents are gelatinous and mucoid (failure to aspirate) or when the cyst wall continues to secrete fluid. Though Pursel reported mediastinoscopic extirpation of benign cysts 35 years ago, it remains a "therapeutic curiosity" with sporadic reports of its usage. We report 2 successful mediastinal cyst extirpations performed as outpatient procedures and review the literature with regards to its management.

Methods: A rigid, 8-mm mediastinoscope was inserted into the anterior mediastinum following the creation of a 2-cm suprasternal incision and dissection along the anterior surface of the trachea. After aspiration, cytology of the contents revealed their benign nature. Right paratracheal cysts in 2 adult males were successfully removed mediastinoscopically by blunt and sharp dissection.

Results: Histopathology revealed benign mesothelial cysts in both instances. Both patients had an uncomplicated procedure and were discharged within 23 hours. No other pathology was detected on mediastinoscopy, and follow-up at 3 months and 6 months has revealed no recurrence.

Conclusion: Mediastinoscopic cyst removal is a minimally invasive procedure with a very low morbidity and mortality rate. Morbidity, recovery, and discharge times are much less than those of more invasive procedures (video-assisted thoracic surgery / thoracotomy). We suggest that it should be the first-choice procedure for the excision of appropriately located benign mediastinal cysts.

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Figures

Figure 1.
Figure 1.
Preoperative computed tomographic scan shows right paratracheal mediastinal cyst in patient 1.
Figure 2.
Figure 2.
Follow-up computed tomographic scan at 12 months shows no recurrence.
Figure 3.
Figure 3.
Preoperative computed tomographic scan shows large right paratracheal cyst.
Figure 4.
Figure 4.
Follow-up computed tomographic scan shows no evidence of recurrence.
See this image and copyright information in PMC

References

    1. Burkell CC, Cross JM, Kent HP, Nanson EM. Mass lesions of mediastinum. Curr Probl Surg. June 1969;2–57 - PubMed
    1. Davis RD, Oldham HN, Sabiston DC. Primary cysts and neoplasms of the mediastinum: Recent changes in clinical presentation, methods of diagnosis, management, and results. Ann Thorac Surg. 1987;44:229–237 - PubMed
    1. Petkar M, Vaideeswar P, Deshpande JR, et al. Surgical pathology of cystic lesions of the mediastinum. J Postgrad Med. 2001;47(4):235–239 - PubMed
    1. Kirwan WO, Walbaum PR, McCormack JM. Cystic intrathoracic derivatives of the foregut and their complications. Thorax. 1973;28:424–428 - PMC - PubMed
    1. Salyer DC, Salyer WR, Eggleston JC. Benign developmental cysts of the mediastinum. Arch Pathol Lab Med. 1977;101:136–139 - PubMed

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