Isolated hydatid cyst of the diaphragm without liver or lung involvement: a case report

Cross-sectional imaging and laparoscopic findings of diaphragmatic mesothelial cysts

AIM

To present cross-sectional imaging, surgical findings, and follow-up results of diaphragmatic mesothelial cysts.

MATERIALS AND METHODS

Radiological findings for location, size, shape, and internal structure of cysts were reviewed retrospectively. For patients that underwent surgery, surgical reports and laparoscopy images were reviewed. In conservatively managed patients, changes in size and imaging findings of the cyst were assessed during follow-up visits.

RESULTS

A total of 13 paediatric cases with an imaging and/or pathological diagnosis of diaphragmatic mesothelial cyst were identified. In all cases, the cystic lesions were located between the diaphragm and the posterolateral aspect of the right lobe of the liver. Eleven lesions (84.6%) had a bi-lobulate shape. Eight of these cases underwent laparoscopic cyst aspiration/unroofing. The postoperative course was uneventful and there were no cases of recurrence. The remaining five cases were managed conservatively with follow-up available in four cases. In three cases (75%), there was reduction in the size of the cysts with a mean volume reduction of 55%.

CONCLUSION

Diaphragmatic mesothelial cysts are congenital cystic lesions that are usually detected incidentally. A common pitfall is incorrect interpretation of the lesion as a hepatic cyst. Conservative management with imaging follow-up can be adopted in asymptomatic cases with typical imaging findings.

Isolated hydatid cyst of the diaphragm, a case report

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Hydatidosis is an endemic disease caused by Echinococcus granulosus.

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Hydatid cysts of the organs other than liver and lung are rare. Isolated diaphragmatic hydatid cyst is even rarer with a few reported cases in literatures.

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We report a case of unique diaphragmatic Hydatid disease.

Introduction

Hydatid disease mainly affect lung and liver. We report a very rare case of hydatid cyst of the diaphragm.

Patient information

A 25-year-old female presented with vague right hypochondrial pain for 2 months. Clinical Findings showed mild tenderness at right hypochondrial region, Ultrasound showed segment 7 hepatic cystic lesion of about 5 × 6 × 7 centimeters, relatively thick wall, with eccentrically coarse calcification. Computed tomography showed cystic lesion affecting segment 7 of the liver with rims of calcification, appearance is consistent with hydatid cyst of the liver. At laparascopy the liver was found to be normal with a bulging from the lateral border of the diaphragm. Postero-lateral mini-thoracotomy was performed and cyst was found to be inside. Resection was done with direct repair of the diaphragm. The histopathogical examination confirmed hydatid cyst of the diaphragm.

Conclusion

Isolated hydatid cyst of the diaphragm is a very rare entity. Pre-operative diagnosis is mandatory to prevent unnecessary excessive incisions.

Imaging findings and management of diaphragmatic mesothelial cysts in children

BACKGROUND

Diaphragmatic mesothelial cysts are rare benign congenital lesions with typical imaging findings.

OBJECTIVE

To present imaging and treatment outcomes in 30 children with diaphragmatic mesothelial cyst.

MATERIALS AND METHODS

We conducted a retrospective chart review and recorded demographic data, imaging findings, treatment and US follow-up results, initial and final volume of the cysts and length of follow-up period for each case of diaphragmatic mesothelial cyst in a specialist hospital.

RESULTS

The study included 30 children (16 girls, age range 1-17 years, mean age 7.9 years) diagnosed with diaphragmatic mesothelial cyst between January 2010 and December 2015. Imaging findings included thin-walled bilobulated or oval-shape cysts located between the diaphragm and right lobe of the liver. Treatment consisted of percutaneous drainage in 17 children and was successful in all. Cysts disappeared completely in 12 of these 17 children (70.5%, 95% confidence interval [CI] 44-90%). Mean volume reduction was 98%. No complication or mortality was seen. The other 13 children were followed with US without treatment. In 4 of these 13 children (30.8%, 95% CI 9-61%), cysts spontaneously decreased in size. No cyst increased in size.

CONCLUSION

In children with typical imaging findings, percutaneous drainage appears safe and effective when treatment is deemed necessary.

Tumors of the diaphragm

Primary tumors of the diaphragm are rare. The most common benign cystic lesions of the diaphragm are bronchogenic or mesothelial cysts, while the most common benign solid lesion is a lipoma. Benign tumors of the diaphragm are resected if they are symptomatic or if there is a doubt about the diagnosis. The most common primary malignant lesion is rhabdomyosarcoma. Malignant tumors are treated based on histology and often with chemotherapy and/or radiation along with surgical resection if feasible. Endometriosis, a benign process that metastasizes to the diaphragm, is typically treated medically; surgical ablation or resection is considered only after failed conservative treatment. Surgical resection of metastatic malignant tumors, such as ovarian cancer and thymoma, as well as malignancies affecting the diaphragm by direct extension, such as mesothelioma, lung, and esophageal cancer, may provide some survival advantage.