Search

Objective: This study aimed to evaluate the feasibility and performance of deep transfer learning (DTL) networks with different types and dimensions in differentiating thymomas from thymic cysts in a retrospective cohort., Materials and Methods: Based on chest-enhanced computed tomography (CT), the region of interest was delineated, and the maximum cross section of the lesion was selected as the input image. Five convolutional neural networks (CNNs) and Vision Transformer (ViT) were used to construct a 2D DTL model. The 2D model constructed by the maximum section (n) and the upper and lower layers (n - 1, n + 1) of the lesion was used for feature extraction, and the features were selected. The remaining features were pre-fused to construct a 2.5D model. The whole lesion image was selected for input and constructing a 3D model., Results: In the 2D model, the area under curve (AUC) of Resnet50 was 0.950 in the training cohort and 0.907 in the internal validation cohort. In the 2.5D model, the AUCs of Vgg11 in the internal validation cohort and external validation cohort 1 were 0.937 and 0.965, respectively. The AUCs of Inception_v3 in the training cohort and external validation cohort 2 were 0.981 and 0.950, respectively. The AUC values of 3D_Resnet50 in the four cohorts were 0.987, 0.937, 0.938, and 0.905., Conclusions: The DTL model based on multiple different dimensions can be used as a highly sensitive and specific tool for the non-invasive differential diagnosis of thymomas and thymic cysts to assist clinicians in decision-making., (© 2024 The Author(s). Thoracic Cancer published by John Wiley & Sons Australia, Ltd.)

Background: Pericardial cysts, though rare and benign, can present with various clinical symptoms depending on their size and location in the body. The detection of these cysts typically relies on imaging studies for a conclusive diagnosis, with surgical removal being the definitive treatment., Case Presentation: This case report details the clinical journey of a 32-year-old Iranian woman with a family history of breast and lung cancer, who experienced left-sided chest pain. Utilizing a combination of clinical history review, mammography, echocardiography, and computed tomography, a precise diagnosis of a 10 cm × 3.5 cm pericardial cyst was achieved. The patient underwent median sternotomy for complete cyst excision., Conclusions: While pericardial cysts are often asymptomatic and benign, they can lead to life-threatening complications. Hence, regular follow-up is advised, and in certain instances, minimally invasive interventions or surgery may be necessary., (© 2024. The Author(s).)

Despite being a rare phenomenon, pericardial hydatid cysts present unique diagnostic challenges and require a multimodality imaging as well as a multidisciplinary approach for a curative management. The authors here present a case of a middle aged man who was referred to them for management of new onset atrial flutter with mitral regurgitation., (© 2024 Wiley Periodicals LLC.)

Competing Interests: Competing interests: None declared.

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.

A pericardial cyst is a rare and benign lesion, most commonly of congenital origin. A female patient of 35 years old was admitted to the emergency department of our institution, for non-irradiating thoracic pain associated with a dyspnea. A CT-Scan was performed, and a pericardial cyst of a large size was found. A surgical procedure through thoracoscopy was performed to enhance the symptomatology of the patient and to eradicate the cyst. The diagnosis of these lesions is most commonly sporadic after a radiography performed for other causes. Most of the time these lesions are asymptomatic (although thoracic pains, chronic cough and dyspnea amongst others may be observed). In case of suspicion (related to radiography or an eventual symptomatology) a thoracic scan is performed with a contrasting product for the confirmation and localization of the cyst. In addition to the diagnosis and the localization, it is best to perform a transthoracic ultrasound which enables a differential diagnosis with other lesions (lipoma, aortic aneurysm, solid tumour, and a left ventricle aneurysm etc.). A surgical treatment is recommended in symptomatic cases. In non-symptomatic cases, a transthoracic ultrasound is recommended.

Neck masses are frequently seen in children. The differential diagnosis includes infectious, congenital and neoplastic lesions. We report a case of rare thymic neck mass in a boy in his middle childhood presented with a history of a left anterolateral neck mass not associated with fever, dysphagia or shortness of breath. The radiographic evaluation showed a picture of a thymopharyngeal duct cyst. Thymic remnant and thymopharyngeal duct cyst are caused by the failure of obliteration and might appear as a lateral neck mass in children. The most effective treatment for a thymopharyngeal duct cyst is total surgical excision. This particular case highlights the importance for clinicians to have a high index of suspicion for a broad differential diagnosis when evaluating paediatric patients who present with neck mass. Additionally, we emphasise the importance of consistently considering thymopharyngeal cyst as differential diagnosis., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: To investigate the value of computed tomography (CT) radiomic feature analysis for the differential diagnosis between thymic epithelial tumors (TETs) and thymic cysts, and prediction of histological subtypes of TETs., Materials and Methods: Twenty-four patients with TETs (13 low-risk and 9 high-risk thymomas, and 2 thymic carcinomas) and 12 with thymic cysts were included in this study. For each lesion, the radiomic features of a volume of interest covering the lesion were extracted from non-contrast enhanced CT images. The Least Absolute Shrinkage and Selection Operator (Lasso) method was used for the feature selection. Predictive models for differentiating TETs from thymic cysts (model A), and high risk thymomas + thymic carcinomas from low risk thymomas (model B) were created from the selected features. The receiver operating characteristic curve was used to evaluate the effectiveness of radiomic feature analysis for differentiating among these tumors., Results: In model A, the selected 5 radiomic features for the model A were NGLDM_Contrast, GLCM_Correlation, GLZLM_SZLGE, DISCRETIZED_HISTO_Entropy_log2, and DISCRETIZED_HUmin. In model B, sphericity was the only selected feature. The area under the curve, sensitivity, and specificity of radiomic feature analysis were 1 (95% confidence interval [CI]: 1-1), 100%, and 100%, respectively, for differentiating TETs from thymic cysts (model A), and 0.76 (95%CI: 0.53-0.99), 64%, and 100% respectively, for differentiating high-risk thymomas + thymic carcinomas from low-risk thymomas (model B)., Conclusion: CT radiomic analysis could be utilized as a non-invasive imaging technique for differentiating TETs from thymic cysts, and high-risk thymomas + thymic carcinomas from low-risk thymomas., (© 2023. The Author(s) under exclusive licence to Japan Radiological Society.)

Mediastinal cysts (MCs) are rare lesions that can arise from embryonic remnants of various mediastinal structures. MCs usually are incidental findings in dogs and cats; however, they can reach a mass-like appearance. The description of MCs on CT in dogs is limited. This retrospective, single-center, descriptive, prevalence study aimed to determine the prevalence of presumed mediastinal cysts (PMCs) in dogs and assess their CT characteristics. Dogs that underwent a thoracic CT scan from January 2019 to August 2021 were included. CT images were evaluated for the presence of PMCs by two diagnostic imaging interns, two last year diagnostic imaging residents, and a board-certified veterinary radiologist. Number, location, margins, shape, volume, size, mass effect, and attenuation values of PMCs were assessed. A total of 866 CT scans were reviewed, and 49 PMCs were identified. The prevalence of PMCs in dogs was 5.66%. English Bulldog and mixed-breed dogs were subjectively overrepresented; however, the possibility of population bias could not be excluded. PMCs were subjectively more frequently observed in male dogs. The PMCs were predominantly round, small, solitary fluid-filled findings localized in the cranioventral mediastinum, with well-defined margins, homogeneous attenuation, and no contrast enhancement. The median attenuation value was 6.32 HU (range: -20.16 to 23.45 HU) precontrast and 7.58 HU (range: -2.45 to 20.79 HU) postcontrast, and the median volume was 1.19 cm 3 (range: 0.02-45.32 cm 3 ). Although the prevalence of PMCs was low in our sample population, findings supported prioritizing a differential diagnosis of incidental PMC for dogs with the above imaging characteristics., (© 2024 American College of Veterinary Radiology.)

Competing Interests: Competing interests: None declared.

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.

A 80-year-old man had spherical abnormality on radiography of the chest. The differential diagnosis includes a tumor, hernia of Morgagni or a pericardial diverticulum. CT-scan demonstrated a pericardial cyst with a diameter of 13 cm. Pericardial cysts are rare and are commonly located at the right cardiophrenic angle.

Abstract: This report presents imaging from a mediastinal mass in a patient with colon cancer. At baseline and surveillance chest computed tomography examinations, it was characterized as a pericardial cyst. However, during chemotherapy, complications arose and this mass was further characterized with a chest MRI. It was then decided to be removed, and histopathology confirmed the diagnosis of a hemangioma., Competing Interests: The authors report no conflict of interest., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

A mediastinal thoracic duct cyst that originates from the thoracic duct is a very rare disease in the mediastinum. There have been no reports of mediastinal thoracic duct cyst infection caused by endoscopic treatment. This is the first case of mediastinal thoracic duct cyst infection after endoscopic submucosal dissection for early esophageal cancer. We herein report a 75-year-old man with mediastinal thoracic duct cyst infection caused by esophageal endoscopic submucosal dissection. In cases where a mediastinal thoracic duct cyst is found before performing endoscopic esophageal treatment, we should carefully consider the potential risk of post-treatment cyst infection.

Rationale: 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., Patient Concerns: 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., Diagnosis: 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., Interventions: Since fetal pericardial cysts keep decreasing in size during maternal pregnancy, follow-up observation measures are taken., Outcomes: Fetal pericardial cysts disappear on their own 4 months after delivery., Lessons: 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., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Sixteen years since their initial description in the literature, posterior mediastinal Mullerian cysts - otherwise known as cysts of Hattori, after their discoverer - remain rare, with only 40 patients reported as of 2020. We report a 43 year old obese female that presented with a 2.6 cm cyst found in the posterior mediastinum by endoscopic ultrasound (EUS) and previously by chest magnetic resonance imaging (MRI) originally diagnosed as a congenital enteric duplication cyst of the esophagus radiologically. Upon surgical excision via a DaVinci thoracoscopy, the cyst was confirmed to be of Mullerian origin by PAX8, WT1, and ER staining. It is possible that the majority of cysts of Hattori remain unrecognized and undiagnosed, given their rarity and resemblance to other pathologies. It is important that this entity become a part of every pathologist's differential for a posterior mediastinal cyst in a female.

We herein report a 34-year-old man who presented with recurrent palpitations that occurred while swallowing solid food. Holter monitoring revealed atrial tachycardia (AT) while eating. In addition, chest computed tomography (CT) showed a small nodule in the front of the ascending aorta. Thoracoscopic surgery was performed to remove the nodule; a pathological examination revealed that the nodule was a thymic cyst. The AT disappeared postoperatively. This case demonstrates that a mediastinal nodule can cause swallowing-induced AT.

Rationale: 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., Patient Concern: A 36-year-old woman presented with progressive left-sided chest pain and exertional dyspnea, with symptoms resembling pleural effusion., Diagnoses: The patient was diagnosed with a pericardial cyst based on imaging and video-assisted thoracoscopic surgery (VATS)., Intervention: VATS was performed., Outcomes: The patient's symptoms improved after successful removal of the pericardial cyst. Follow-up chest computed tomography exhibited no evidence of recurrence., Lessons: 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., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Benign cystic mesotheliomas (BCMs), also known as multilocular mesothelial inclusion cysts, inflammatory inclusion cysts or multicystic mesothelial proliferation, are frequently observed in females and are localised localised in the pelvic peritoneum. They are rarely present in the thoracic and mediastinal areas; however, these locations have been reported in a few cases in the literature., Case Presentation: We present the case of a woman with an intrathoracic BCM. A 28-year-old female patient presented with a cystic mass of 8 × 6 × 6 cm in the left hemithorax shown by computed tomography of the thorax. The patient underwent cystic mass excision with video-assisted thoracoscopic surgery (VATS), which was completed without complications. The diagnosis was confirmed histopathologically after the surgical resection., Conclusions: Due to BCMs' non-specific clinical symptoms and radiological imaging, preoperative diagnosis is difficult, and they are often confused with pericardial cysts. There is no standard treatment protocol; however, VATS and en bloc resection are the most frequently used treatment options for mediastinal localization. Since these lesions slow proliferation rates have the potential for local recurrence and low malignant transformation, close follow-up is recommended. In this case report, we aimed to present a rare BCM case with intrathoracic paracardiac localization was completely excised through VATS. No recurrence has been detected in three years of follow-up.

A 47-year-old man presented with hematuria. Computed tomography( CT) showed a posterior mediastinal cyst. Chest magnetic resonance imaging showed a well defined mass with high intensity on T2-weighted images. Echocardiogram revealed severe aortic regurgitation, moderate mitral regurgitation and no continuity between the cyst and the pericardium. We performed aortic valve replacement, mitral annuloplasty and cyst resection after confirming it was not malignant by intraoperative rapid pathological examination. We performed sufficient and safe cyst resection through full sternotomy under cardiac arrest. Pathological examination revealed that cyst was bronchogenic. Bronchogenic cyst has malignant potential and it is very difficult to resect after presenting symptoms. We need to consider the differential diagnosis, the timing of operation and operative strategy.

BACKGROUND Pericardial cyst is a rare benign mass of the mediastinum. More than two-thirds of pericardial cysts are located in the right cardiophrenic angle and less than one-third in the left cardiophrenic angle. Most cases are asymptomatic and discovered incidentally during to thoracic imaging such as chest X-ray, CT scans, and transthoracic echocardiograms. When pericardial cysts present with symptoms, they are often persistent and non-specific and include chest pain, dyspnea, and persistent cough. The optimal management of pericardial cysts is unclear, and no large studies regarding safety, efficacy, and long-term follow-up exist. Management strategies include cyst resection with sternotomy, thoracotomy or video-assisted thoracic surgery, cyst aspiration, and sclerosis after aspiration. The optimal mode of follow-up for asymptomatic cases is also unclear. Here, we present a case of a large pericardial cyst in the left cardiophrenic angle in a middle-aged Danish woman with persistent and unresolved dyspnea and chest pain. CASE REPORT A 57-year-old woman was referred for transthoracic echocardiography because of year-long cough and left-sided chest pain, which were exacerbated in the supine position. The echocardiography revealed a large cyst-like structure over the left ventricle. A cardiac CT scan and MRI scan were performed, confirming the presence of a large pericardial cyst with no communication with the pericardium. The cyst was surgically removed via thoracotomy. CONCLUSIONS Pericardial cysts should be considered as a rare differential diagnosis, giving rise to common cardio-pulmonary symptoms such as chest pain, dyspnea, and cough.

Competing Interests: Conflict of interest: None declared.

Haemorrhagic pericardial cysts are rare and may be complicated by encasement of the heart, right heart failure and, rarely, cardiac cirrhosis. Surgical management of complicated cysts is challenging and has poor outcomes. We report a case of successful surgical management of a complicated pericardial cyst presenting with cardiac cirrhosis and the challenges associated with this condition., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)

A woman in her 70s presented with an enlarging, asymptomatic palpable mass in the left supraclavicular fossa. The clinical impression was of a lipoma. Imaging showed a cystic lesion with continuity of a tubular structure leading to the carotid sheath. Cytology was consistent with thoracic duct sampling. A diagnosis of the rare entity of a thoracic duct cyst with supraclavicular extension was made. This was managed conservatively via repeated aspirations which reduced the size of the mass., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To explore the features and diagnostic value of computed tomography (CT) imaging in cases of thymic cysts., Methods: A total of 24 cases of the thymic cysts (confirmed by postoperative pathology) were retrospectively analyzed. The location, morphology, and density of the thymic cysts were summarized, and the changes in CT value of the region of interest (ROI) in the thymic cysts between noncontrast enhanced and enhanced chest scans were compared and classified., Results: The average long-axis dimension was 17.50 ± 6.00 mm, the CT value range across the 24 cases was 5-81 HU, and the average CT value of the noncontrast enhanced scans was 39.75 ± 20.66 HU. The CT value in the noncontrast enhanced scan was >20 HU in 79% of the sample cases. The CT value in the ROI of the thymic cysts under enhanced scan showed a significant decrease in 15 cases, a significant increase in 5 cases, and an insignificant change in 4 cases., Conclusion: The CT values of the thymic cysts in the enhanced scans were generally lower than in the noncontrast enhanced scans, which might be a valuable finding for thymic cysts diagnosis., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 Zhi-Liang He et al.)

Purpose: The aim of the study was to evaluate cystic thymic masses by using computed tomography (CT) and magnetic resonance (MR) scoring systems to differentiate nonneoplastic thymic cysts from cystic thymic neoplasms., Methods: This retrospective multisite study included adult patients who underwent CT and MR imaging of the chest between 2007 and 2020 with any of the following impressions on cross-sectional imaging studies: "thymic mass with cystic component," "unilocular or multilocular cystic thymic lesion," "complex thymic cyst," "thymic cyst with hemorrhage." Two blinded radiologists reviewed and recorded specific imaging features as well as overall impressions on both CT and MR using a Likert scale scoring system. Data were analyzed, and diagnostic accuracy of CT and MR was compared using areas under the receiver operating characteristic curves (AUC)., Results: Fifty-six patients were included, of which 45 (80%) had benign masses. Total of 21 patients (38%) had indeterminate scores on CT of which 3 (14%) were malignant, while only 6 (11%) had indeterminate scores on MR and 1 was malignant. Magnetic resonance scoring system (AUC, 0.95) performed better than CT scoring system (AUC, 0.86) in distinguishing benign versus malignant lesions (P = 0.06). Lack of enhancement within the mass was completely predictive of benign etiology (P < 0.001). Wall thickness of an enhancing cyst was predictive of malignancy, with AUC 0.93., Conclusions: Magnetic resonance yielded higher specificity allowing a larger number of lesions to be confidently assigned a benign diagnosis. This could help in averting unnecessary follow-up, biopsies, or surgery. The authors recommend follow-up imaging with MR for prevascular masses, even those appearing "solid" on CT., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Pericardial cysts are rare mediastinal abnormalities, generally benign, discovered most often incidentally in the course of diagnostic investigations involving the cardiac profile. They have an incidence of 1 case in 100 000 and are mostly located at the right cardiophrenic angle. Spontaneous resolution of cysts is even rarer. We describe an intricate case report in which the cyst was discovered incidentally and was no longer detected at cardiac magnetic resonance performed 7 years after the first diagnosis. The presence of an asymptomatic pericardial cyst should be regularly followed up over time for the potential risks of complications related to its growth but also because over time, although rarely, it may no longer be detected as in the case presented.

Thymic cancer associated with spontaneous regression of thymic cysts is a rare disease. A 47-yearold man was referred to our hospital for right chest pain and chest abnormal shadow. Chest computed tomography( CT) revealed a solid lesion 1.3 cm in diameter and a cystic lesion 1.0 cm in diameter at the right anterior mediastinum. A second CT study after six months showed a solid lesion increased to 1.7 cm in diameter and a cystic lesion reduced to 0.7 cm in diameter. A second magnetic resonance imaging (MRI) showed a cystic lesion reduced and high signal intensity region in the thymus enlarged on T2-weighted imaging. Under the diagnosis of thymoma associated with multilocular thymic cysts, total thymectomy was performed for these mediastinal lesions by video-assisted thoracic surgery. Histopathological finding was thymic squamous cell carcinoma (Masaoka stage II) associated with multilocular thymic cysts. Additional postoperative radiotherapy was performed, and there has been no recurrence after one postoperative year.

Mullerian cysts are benign tumors that are very rare in the posterior mediastinum. It is necessary to distinguish Mullerian cysts from benign tumors or other types of cyst in the posterior mediastinum. A 42-year-old woman visited our hospital for a routine check-up, and a mediastinal mass was identified on chest computed tomography (CT). Contrast-enhanced chest magnetic resonance imaging (MRI) revealed a 4.0 × 2.6 × 2.8-cm mass, and a neurogenic tumor or esophageal cyst was suspected. Single-port thoracoscopic surgery was performed for cyst removal. Histopathological examination of the resected tissue revealed that the cyst wall was covered with a single layer of ciliated columnar epithelium. Immunohistochemical staining revealed positivity for paired box gene 8 (PAX8), Wilms tumor protein 1 (WT-1), estrogen receptor (ER), and progesterone receptor (PR). Therefore, a diagnosis of mediastinal Mullerian cyst was made. Mediastinal Mullerian cysts should be included in the differential diagnosis of posterior mediastinal cysts. Cystic lesions in the posterior mediastinum should be removed surgically and undergo immunohistochemical examination.

Cystic lesions of the anterior mediastinum represent a well-known group of benign lesions that are relatively common in the general practice, namely in the pediatric age group. In the adult population, multilocular thymic cyst (MTC) plays an important role in occurrence as it presents as a cystic anterior mediastinal mass that clinically may mimic another anterior mediastinal tumor. In general, MTC is of rather unusual occurrence and its histopathological features have been well described in the literature. However, similar histopathological features may also be associated with a gamut of other tumoral conditions that although unrelated may be encountered growing along the walls of these cystic structures. Herein a presentation of the classical MTC and the classical histopathological features of such entity in association with other tumoral conditions will be discussed. It is highly important to underscore that the final interpretation of some of these tumors is based on a thorough evaluation of the cystic lesion and a reasonable sampling for histological evaluation so that the proper interpretation can be reached. Needless to say, the radiological and clinical information of the patients with cystic anterior mediastinal lesions is very important in the final analysis of these cases., (Copyright © 2021. Published by Elsevier Inc.)

We present a unique case of a 41-year-old man with an anterior mediastinal mass and a pulmonary nodule, found incidentally on a thoracic CT. Further evaluation with an MRI revealed a thymic cyst which was multiloculated with several septations. Biopsy of the pulmonary nodule was performed and histology was consistent with a solitary fibrous tumour (SFT), on the benign spectrum. Both lesions were successfully resected simultaneously via a median sternotomy approach. Final full histological diagnoses confirmed a multiloculated thymic cyst and a completely excised SFT., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

The multilocular thymic cyst (MTC) is a rare, acquired disease caused by inflammatory changes in the thymus, and is associated with autoimmune diseases. We report a case of MTC with thrombocytopaenia, which improved following surgical resection. A 45-year-old man developed thrombocytopaenia with an anterior mediastinal tumour. Thrombocytopaenia due to an autoimmune mechanism, associated with thymoma or thymus-related disease, was suspected. Pathologic analysis following thoracoscopic thymectomy confirmed MTC. The platelet level recovered postoperatively. Our findings suggested a relationship between the acquired formation of MTC and the development of autoimmune antibodies. However, further investigation is needed to obtain more information., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Aim: To explore the utility of multiple energy spectrum computed tomography (CT) parameters in distinguishing thymic epithelial tumours (TETs) from thymic cysts among lesions <5 cm in diameter., Materials and Methods: Data pertaining to 56 patients with TETs and thymic cysts <5 cm in diameter were assessed retrospectively. All patients underwent surgical resection and the diagnosis was confirmed histopathologically. Thirty-five patients with TETs (average age, 51.97 years) and 21 patients with thymic cysts (average age, 50.54 years) were included. The region of interest for the lesion on the energy spectrum CT was delineated on the post-processing workstation, and multiple parameters of the energy spectrum CT were obtained. The diagnostic efficacies of the parameters were analysed using receiver operating characteristic (ROC) curves., Results: To distinguish small TETs from thymic cysts, a single-energy CT value of 60 keV showed good differential diagnostic performance in the arterial phase (cut-off value = 68.42 HU; area under the curve [AUC] = 0.978), a single-energy CT value of 70 keV showed good differential diagnostic performance in the venous phase (cut-off value = 59.77 HU; AUC = 0.956). In the arterial and venous phases, effective atomic numbers of 8.065 and 8.175, respectively, were used as cut-off values to distinguish small TETs from thymic cysts (AUC = 0.972 and AUC = 0.961, respectively). Iodine concentrations of 10.99 and 11.05 were used as cut-off values to distinguish small TETs from thymic cysts (AUC = 0.956 and AUC = 0.924, respectively)., Conclusion: According to the present study, energy spectrum CT parameters may have clinical value in the differential diagnosis of TETs and thymic cysts., (Copyright © 2021 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Mediastinal bronchogenic cysts, regarded as congenital foregut abnormalities, are uncommon. These cysts can compress adjacent structures, causing obstructive symptoms and complications. A 57-year-old man was admitted to our hospital with complaints of tachycardia, dyspnea, and chest pain. Enhanced computed tomography revealed a 90 × 90 mm, well-defined subcarinal cystic mass causing significant compression and stenosis of the right main bronchus, right pulmonary artery, and right inferior pulmonary vein. The mass was successfully excised using one window and two-port video-assisted thoracoscopic surgery with partial resection and repair of pulmonary artery, and the postoperative course was good with no recurrence., (© 2021. The Japanese Association for Thoracic Surgery.)

Pericardial cysts are infrequent mediastinal entities. They can mimic cardiac chamber enlargement, phrenic hernia, malignancy, bronchogenic cysts, pleurisy, dextrocardia. Diaphragmatic elevation can also be misdiagnosed in some cases. The reports about huge pericardial cyst mimicking the left diaphragmatic elevation (paralysis) are not common. The correct diagnosis of pericardial cyst can be difficult due to unremarkable complains and non-specific findings on chest radiography. In this report we have presented a rare clinical case described as the huge pericardial cyst mimicking a false left diaphragmatic paralysis. The combination of different radiological technics (CT-scans, barium esophago-gastrography etc.) are useful to correct preoperative diagnosis. Transthoracic (intercostal) accesses are the dominant to operate on patients with huge pericardial cysts.