Thymic cyst presenting as Horner's syndrome

Intrathoracic schwannoma with Horner syndrome

Horner syndrome (HS) results from the interruption of the sympathetic pathway to the eye and face, and describes a collection of signs consisting of ipsilateral miosis, partial ptosis, anhidrosis and apparent enophthalmos. It is a clinical observation, and has a plethora of possible causes, ranging from the benign to the malignant. Involvement of the stellate ganglion on the sympathetic chain by malignant tumours of the lung is a well-recognised cause of HS. On the other hand, HS secondary to the excessive growth of a benign intrathoracic neoplasm is a very rare finding, with only a few cases described in the literature. Our patient was found to have such a diagnosis when he presented to medical attention with a 1-month history of cough that was associated with features of HS that he had ignored for the preceding 9 years.

Complete recovery of an isolated left vocal fold palsy associated with a benign mediastinal thymic cyst

OBJECTIVES

To present a case of benign mediastinal thymic cyst, and to review the published information on these cysts, including their incidence, presentation, diagnosis and management.

METHODS

We report the case of a 55-year-old man who presented with a unilateral vocal fold palsy subsequently found to be due to the presence of a benign mediastinal thymic cyst. A literature search was undertaken to identify the incidence, key features and management of this rare condition.

RESULTS

Benign mediastinal thymic cysts are a rare cause of mediastinal masses. Usually diagnosed incidentally, their management is usually surgical. Vocal fold palsy in isolation has not previously been reported in association with mediastinal thymic cysts.

CONCLUSION

This report describes what we believe to be the first published case of a completely reversible vocal fold palsy presenting in association with a rare benign mediastinal thymic cyst.

Thymic cyst causing superior venacava syndrome relieved by mediastinoscopy--a rare presentation

Superior venacava obstruction is most often caused by intrathoracic malignant masses. The commonest cause of benign superior venacava obstruction is fibrosing mediastinitis. A thymic cyst causing marked superior venacava obstruction is very rare and has not been reported. We hereby present a case of a 40-year-old man with such a finding who presented with chest pain and facial congestion. Evaluation revealed a mediastinal mass causing marked superior venacaval obstruction. He underwent a mediastinoscopy, which showed a cyst. It was drained following which there was complete resolution of symptoms post-operatively. Histopathology of the lesion confirmed a thymic cyst.

Clinical spectrum of mediastinal cysts

OBJECTIVES

Congenital cysts of the mediastinum are an uncommon but important diagnostic group, representing 12 to 30% of all mediastinal masses. The purpose of this study was to review our institutional experience with congenital cysts of the mediastinum, emphasizing the clinical spectrum of the disease.

DESIGN

Retrospective study.

OBJECTIVES

University hospital unit of general thoracic surgery.

METHODS

We retrospectively reviewed the records of 105 patients with cysts of the mediastinum (50 male and 55 female patients) who comprised 13.0% of mediastinal masses over the past 50 years.

RESULTS

There were 10 pediatric patients (< 15 years old) and 95 adult patients. The prevalence of cysts in the adult populations was higher than that in children (14.1% vs 7.7%, p < 0.05). There were 47 bronchogenic cysts, 30 thymic cysts, 12 pericardial cysts, 7 pleural cysts, 4 esophageal duplications, 2 meningoceles, 1 thoracic duct cyst, and 2 others. MRI has become a useful tool for providing supplemental data in combination with CT. Overall, 38 patients (36.2%) with mediastinal cysts were symptomatic, including 39.2% with bronchogenic/esophageal cysts, 40% with thymic cysts, and 15.8% with pericardial/pleural cysts. One hundred patients had complete resection of their masses, 3 patients with pericardial diverticulum received a thoracoscopic fenestration without mortality, and 2 patients refused surgery.

CONCLUSION

Early recognition of these relatively rare lesions would lead to immediate and appropriate surgical intervention. Early surgical intervention is also important because definitive histologic diagnosis can only be established by means of surgical extirpation.

Intermittent brachiocephalic vein obstruction secondary to a thymic cyst

Mediastinal thymic cysts are usually asymptomatic and found incidentally on a routine chest roentgenogram. Rarely, they may cause symptoms of vascular obstruction. A 55-year-old woman presented with intermittent swelling in her left neck. The swelling was positional and was worse while supine and disappeared while upright. Evaluation revealed a thymic cyst causing extrinsic compression of the left brachiocephalic vein. The cyst was resected with complete resolution of the left neck swelling.

Horner's syndrome resulting from a prolonged abnormal posture during a coma

BACKGROUND

Horner's syndrome results from the impairment of the sympathetic nerve supply to the eye and orbit. Other nerve palsies from prolonged unchanged posture are well described, but Horner's syndrome following prolonged lateral flexion has only twice been seen previously and these cases were in association with anaesthesia.

METHODS/RESULTS

A case is described of Horner's syndrome resulting from a prolonged period of unchanged posture from an alcohol-induced coma. A review of the anatomy of Horner's syndrome is presented.

CONCLUSION

To my knowledge, this is the first reported case of Horner's syndrome resulting from a coma.

Non-nodal neck masses

Planar imaging has made significant contributions to the evaluation of patients with non-nodal neck masses. The clinical history, physical examination, and imaging characteristics of these lesions are often complimentary. Yet, planar imaging much more accurately defines the size, location, and extent of these lesions than is revealed on physical examination. The CT and MR characteristics are often sufficiently specific to arrive at the correct preoperative diagnosis in these patients. We present the classical radiographic and clinical features of several non-nodal neck masses.