A 57-year-old woman presented to our hospital with chest and shoulder pain. A giant mediastinal cystic lesion extending from the apex to the inferior perihilar area on the right hemithorax was detected radiologically. The patient underwent video-assisted thoracoscopic surgery. The intraoperative lesion was identified as a hydatid cyst and resected thoracoscopically (Figure 1).
(A) Axial, (B, C) coronal, and (D) sagittal thoracic computed tomography sections show a mediastinal cystic lesion of approximately 10 x 4 cm (arrowheads) extending from the apex to the perihilar area in the right hemithorax. (E, F) The lesion was diagnosed intraoperatively as a hydatid cyst (arrow, laminated membrane; circle, cyst cavity).
Hydatid cysts caused by metacestode forms of Echinococcus granulosus are commonly located in the liver and lungs. The mediastinal involvement rate is 0.61%, and primary mediastinal localization is less common11. Aydin Y, Ulas AB, Ince I, Korkut E, Ogul H, Eren S, et al. Large Case Series Analysis of Cystic Echinococcosis. Indian J Surg (2021). https://doi.org/10.1007/s12262-021-03061-0.
https://doi.org/10.1007/s12262-021-03061...
. Symptoms depend on the cyst size, location, and compression on adjacent structures, such as the esophagus, aorta, trachea, vena cava, and phrenic nerve22. Aydin Y, Gursan N, Turkyilmaz A, Eroglu A. Mediastinal calcified hydatid cyst. Ann Thorac Surg. 2011;92(4):e85.,33. Aydin Y, Ogul H, Turkyilmaz A, Eroglu A. Surgical treatment of mediastinal cysts: report on 29 cases. Acta Chir Belg. 2012;112(4):281-6.. Although primary giant mediastinal hydatid cysts are rare, they should be considered in the differential diagnosis of all mediastinal lesions.
REFERENCES
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1Aydin Y, Ulas AB, Ince I, Korkut E, Ogul H, Eren S, et al. Large Case Series Analysis of Cystic Echinococcosis. Indian J Surg (2021). https://doi.org/10.1007/s12262-021-03061-0.
» https://doi.org/10.1007/s12262-021-03061-0 -
2Aydin Y, Gursan N, Turkyilmaz A, Eroglu A. Mediastinal calcified hydatid cyst. Ann Thorac Surg. 2011;92(4):e85.
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3Aydin Y, Ogul H, Turkyilmaz A, Eroglu A. Surgical treatment of mediastinal cysts: report on 29 cases. Acta Chir Belg. 2012;112(4):281-6.
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Financial Support: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publication Dates
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Publication in this collection
19 Sept 2022 -
Date of issue
2022
History
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Received
09 May 2022 -
Accepted
10 June 2022