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CURRENT ISSUETHE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery


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The Journal of Cardiovascular Surgery 2000 February;41(1):137-41

THORACIC PAPERS 

 ORIGINAL ARTICLES

Subcarinal foregut cysts. A unique clinical problem

Zikri M. A., Rice T. W.

From The Department of Thoracic and Cardiovascular Surgery The Cleveland Clinic Foundation, Cleveland, USA

Background. To eval­u­ate the ­risks asso­ciat­ed ­with a sub­car­i­nal fore­gut ­cyst in a ­fixed med­i­as­ti­nal ­space.
Methods. Design: Between January 1, 1986, and August 1, 1997, 8 ­patients who had sub­car­i­nal ­cysts and who under­went sur­gi­cal inter­ven­tion ­were iden­ti­fied. These ­results ­were ana­lyzed to iden­ti­fy asso­ciat­ed symp­toms and ­results of sur­gi­cal inter­ven­tion. Mean dura­tion of fol­low-up was 37.3±2.2 ­months and was 100% com­plete. Patients: Of the ­eight ­patients, ­three ­were men. Mean age was 45.6±15.6 ­years (­range 24-66). All ­patients ­were symp­to­mat­ic. Six ­patient suffered res­pir­a­to­ry dis­tress. Four ­patients com­plained of ­chest ­pain. Preoperatively, all ­patients under­went rou­tine ­chest radiog­ra­phy. Six ­patients under­went com­put­ed ­chest tomog­ra­phy (CT); 4 ­patients had mag­net­ic res­o­nance image­ry (MRI) of the ­chest. Cardiac ech­o­car­di­og­ra­phy was per­formed on 4 ­patients and eso­phag­o­gas­tro­du­o­de­nos­co­py (EGD) ­with or with­out ­eso-phageal ultrasound (EUS) was ­done in 4. Of 7 ­patients who under­went bron­chos­co­py, 6 ­patients dem­on­strat­ed extrin­sic air­way com­pres­sion. The remain­ing ­patient ­showed fis­tu­lous com­mu­ni­ca­tion. Intervention: Cyst dimen­sions ­ranged ­from 7.33±1 cm (­mean±SD). Total resec­tion of the ­cyst was accom­plished in 6 ­patients. One ­patient ­with fis­tul­iza­tion under­went ­right ­main bron­chi­al ­sleeve resec­tion. Histopathology ­revealed inflam­ma­tion of the ­cyst in 2 cas­es and cal­cifi­ca­tion of the ­cyst ­wall in 1. Fluid ­from one ­cyst ­grew ­gram pos­i­tive coc­ci.
Results. Length of hos­pi­tal ­stay ­ranged ­from 10.9±4.4 ­days. There ­were no mor­tal­ities. Morbidity includ­ed pro­longed ven­ti­la­tion (1), pul­mo­nary embo­lism (1) and ­left recur­rent laryn­geal pal­sy (1).
Conclusions. Our ­results cor­rob­o­rate the ­need for sur­gi­cal exci­sion of sub­car­i­nal sub­type ­cysts to pre­vent the devel­op­ment of med­i­as­ti­nal com­pres­sion and oth­er ­cyst-relat­ed com­pli­ca­tions.

language: English


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