Localisation cervico-thoracique d’un kyste hydatique

[Hydatidosis bone wall chest: About three cases]

INTRODUCTION

Bone hydatidosis of the chest wall is rarely reported in the literature. Costal and sternal location are uncommon. Through 3 observations and literature review, we report particular pathophysiological and diagnostic aspects of costal and sternal hydatidosis. We also discuss therapeutic and prognostic aspects of this disease. OUR CASES: we report the cases of 45, 41 and 17 years old male patients, 2 of them had previous surgery for thoracic wall mass in general surgery service. Clinical presentation was thoracic wall painful mass sticking to bone. One patient had isolated costal location, the 2 others had sternal location; in one of them, the disease is located in sterno-costo-clavicular area. In all 3 cases, the disease was diagnosed by computed tomography (CT) scan, showing bone lysis or mediastinum enlargement. Patients undergo extended bone resection removing away all destructed parts of the bone. After surgery, albendazole has been prescribed to all patients. No recurrence was observed after 12 months follow-up.

CONCLUSION

Chest wall bone hydatidosis is unusual even in endemic regions, with slow evolution and inconspicuous symptoms. Radiology plays a key role in the management of this disease. Extended surgical resection associated with medical treatment (albendazole) is a reliable treatment without recurrence.

Cervico mediastinal teratoma in adult: A very rare presentation

Teratoma is a rare presentation in adult, specifically in cervico-mediastinal region. We reported two adult patients with diagnosis of cervico-mediastinal teratoma and operated them. In adult patients who present with cervico-mediastinal mass, benign teratoma could be one of a differential diagnosis although it is a rare presentation.

Mediastinal hydatid cyst: a case report

INTRODUCTION

Mediastinal localization of hydatidosis is very rare even in endemic areas. The diagnosis is based on typical clinical and radiological criteria.

CASE PRESENTATION

We report a case of a mediastinal location of hydatidosis in a 60-year-old Arab man admitted for chest pain. The chest radiograph showed a rounded and homogeneous opacity. Computed tomography showed a right mediastinal cyst, without other thoracic or abdominal sites. Through a posterolateral thoracotomy, we found a cystic mass in the posterior mediastinum. The patient received a cystectomy with medical treatment based on albendazole. He improved a few weeks later.

CONCLUSION

Mediastinal cysts remain rare, even in endemic countries, which makes initial diagnosis difficult. Our observation shows the importance of keeping this diagnosis in mind when a patient presents with signs of mediastinal compression.

[An anterior mediastinal mass of rare etiology]

Hydatid cyst of the mediastinum is very uncommon. The diagnosis, usually evident in endemic regions in the case of a typical clinical-radiological presentation, is rather more difficult in certain atypical forms. We report a case of a 19-year-old man who presented with a mass of tumour like appearance in the anterior mediastinum. The diagnosis of mediastinal hydatid cyst was established by transthoracic needle biopsy and endoscopic bronchial aspiration revealed hydatid membranous debris. The diagnosis was confirmed when the mediastinal cyst ruptured into a bronchus. Thoracotomy was carried out with an uneventful post-operative recovery. This observation illustrates the diagnostic difficulties when a mediastinal hydatid cyst presents the appearances of a tumour. This possibility must be included in the differential diagnosis of every mediastinal mass, particularly in endemic regions.

[Hydatid cyst of the mediastinum: 14 case reports]

PURPOSE

The objective of this study was to describe the different radiological features of the hydatid cyst of the mediastinum.

MATERIALS AND METHODS

We conducted a retrospective study on 14 patients (seven women, seven men), diagnosed with mediastinal hydatid cyst, aged 13-67 years (mean, 48 years) over a period of 16 years in our hospital where 71 cases of hydatid disease are annually diagnosed. The patients were explored by chest radiography (n=14), chest ultrasonography (n=10), abdomen ultrasonography (n=14), computed tomography (CT scan) (n=13), and magnetic resonance imaging (MRI) (n=8).

RESULTS

The chest x-ray showed an opacity of the anterior (n=11), middle (n=1), and posterior (n=1) mediastinum. The thoracic ultrasound confirmed the liquid nature of the mass with a multivesicular aspect (n=9). CT and thoracic MRI made it possible to precisely locate the mediastinal compartment involved and study the relationship to adjacent structures. A purely mediastinal location was found in only six cases. In the remaining cases, it was associated with hepatic (n=7) and pleural (n=1) locations.

CONCLUSION

Hydatid cysts of the mediastinum are very uncommon. Diagnosis can be made by chest sonography. CT scan is the main tool for diagnosis and the study of possible extension. Our study showed a more frequent location to the anterior mediastinum.

Kyste hydatique des tissus mous : apport de l’IRM (À propos de trois observations)

Three cases of hydatid disease of the soft tissues are reported. All presented as soft tissue lesions in the neck and lower extremities. All three cases were studied with ultrasound (US) and magnetic resonance (MR) imaging techniques. Two patients presented with multivesicular lesions, which were considered diagnostic for hydatid disease. The third showed a lesion with hypoechoic solid and lobulated pattern mimicking lymph node. MR outlined the cystic pattern with intense peripheral enhancement and was suggestive of an infected cystic lesion. Surgery was performed in all three cases. Hydatid disease presenting in the soft tissues can be diagnosed with confidence, when US and/or MR shows multivesicular lesions. MR appears to be the most useful imaging technique when a complex or solid pattern is present. Enhancement of the peri-cystic soft tissues can be considered as a suggestive MR feature of soft tissue hydatid disease.