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Mediastinal cysts

Mediastinal cysts. James Montgomery, DVM November 3, 2008. Mediastinal cysts. Infrequently occur Congenital or idiopathic Origin: Pleural Branchial Parathyroid Thyroglossal Lymphatic Bronchogenic Thymic. Clinical signs. Generally none Respiratory difficulty Space occupying.

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Mediastinal cysts

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  1. Mediastinal cysts James Montgomery, DVM November 3, 2008

  2. Mediastinal cysts • Infrequently occur • Congenital or idiopathic • Origin: • Pleural • Branchial • Parathyroid • Thyroglossal • Lymphatic • Bronchogenic • Thymic

  3. Clinical signs • Generally none • Respiratory difficulty • Space occupying

  4. Patient ID: 132472 • Allie • 9 year old • Spayed female • Domestic shorthair Weight loss, lethargy

  5. Radiographs - 106076

  6. Radiographs - 106076

  7. Radiographs - 106076

  8. Differential diagnoses • Abscess • Granuloma • Lymphadenopathy • Hematoma • Ectopic thyroid tissue • Cyst • Neoplasia • Lymphosarcoma, thymoma

  9. Ultrasound - 106086

  10. Ultrasound - 106086

  11. Ultrasound - 106086 • Aspirated 8mL golden brown fluid • Cytology: WBC=200/ul; Protein=0.3 g/dl. • Extremely low cellularity. • Contains only rare erythrocytes and debris. • No etiologic agents observed • Interpretation: Low cellularity, low protein fluid. Consistent with idiopathic mediastinal cyst

  12. Treatment options • In the absence of respiratory signs, intervention is not warranted (Zekas LJ, Adams WM. Vet Radiol Ultrasound 2002;43:413-8) • Generally considered an incidental finding • Surgical removal • Functional cysts (parathyroid) • Space-occupying disease • Tracheal or vascular compression

  13. Differentiating cysts • Histologic evaluation needed • Clinical findings: • Thymic branchial cysts • Dyspnea, pleural effusion, aspiration of mucinous fluid • Multicystic appearance • Thymic branchial cysts • Lymphangiomas • Cystic thymomas

  14. Embryology • 4 embryologic pharyngeal pouches • Abnormal development may lead to formation of cystic structures in the neck and cranial mediastinum • 1st – Eustachian tube (middle ear) • 2nd – Supratonsillar fossa • Branchial cysts • 3rd – Thymus and cranial parathyroid glands • 4th – Caudal parathyroid glands & contributes to thyroid gland formation • Thyroglossal cysts – abnormal development near site of origin of the thyroid diverticulum

  15. Summary • Opacities in the cranial mediastinum on thoracic radiographs should be investigated • Ultrasonographic identification of an anechoic mass with clear fluid supports diagnosis of mediastinal cyst • Majority of feline cranial mediastinal cysts are benign with no need for treatment

  16. References • Ellison GW, et al. Idiopathic mediastinal cyst in a cat. Vet Radiol Ultrasound 1994;35:347-9. • Moore LE, Biller DS. Mediastinal disease. In Ettinger SJ, Feldman EC, eds. Textbook of Veterinary Internal Medicine, 6thed (St. Louis, MO: Elsevier Saunders, 2005) pp. 1268-9. • Swainson SW, et al. Radiographic diagnosis: mediastinal parathyroid cyst in a cat. Vet Radiol Ultrasound 2000;41:41-3. • Zekas LJ, Adams WM. Cranial mediastinal cysts in nine cats. Vet Radiol Ultrasound 2002;43:413-8.

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