膈肌支气管源性囊肿误诊为肺囊肿一例

支气管源性囊肿为一种先天性病变,发生于膈肌罕见。该文报道1例膈肌支气管源性囊肿被误诊为肺囊肿的患者。其为46岁女性,因行胸部CT检查发现胸腔内肿块入院,结合MRI结果,术前诊断为右下肺囊肿,排除手术禁忌证后于胸腔镜下切除囊肿,术中发现囊肿发生于膈肌,与右下肺组织分界清晰,最终病理诊断为膈肌支气管源性囊肿。术后随访半年,患者情况良好。     

Intracystic hemorrhage in a non-endometriotic mullerian vaginal cyst

The commonest type of simple vaginal cyst is the Mullerian cyst. These are typically lined by columnar epithelium and contain serous or mucinous fluid. If blood is found in the cyst, the source is usually due to the presence of endometrial elements in the cyst wall. The cyst is then termed an endometriotic cyst. In this case report, we have described a woman with a symptomatic 3 cm upper vaginal cyst who underwent surgical excision of the cyst. The cyst cavity was found to be full of old dark blood and mucous, however the wall contained no endometrial tissue and was lined by columnar epithelium which stained positive for mucous with mucicarmine. No cause for the intracystic hemorrhage was identified. We conclude that intracystic hemorrhage can occur in a simple Mullerian vaginal cyst in the absence of endometrial components.     

Giant infected hepatic cyst causing exclusion pancreatitis: A case report

BACKGROUNDAn infected hepatic cyst causes clinical symptoms, such as fever and abdominal pain. A cyst with a diameter > 10 cm increases the likelihood of exclusion symptoms in adjacent organs. Herein, we report a case of pancreatitis caused by an infected hepatic cyst. CASE SUMMARYThe patient was an 88-year-old woman with a history of polycystic liver disease and a cyst > 10 cm in diameter. She was referred to our hospital for upper abdominal pain that persisted for four days before consultation. She had a fever of 37.4ºC, and a blood test showed a C-reactive protein level of 23 mg/dL. An infected hepatic cyst was diagnosed by abdominal ultrasonography, computed tomography, and magnetic resonance imaging. Antibacterial therapy and percutaneous cyst puncture did not elicit sufficient therapeutic effects. As the cyst growth continued, laparoscopic hepatic cyst fenestration was performed on hospitalization day 20. Thereafter, symptoms improved, and she was discharged on hospital day 31.CONCLUSIONTo our knowledge, this is the second case report of pancreatitis associated with hepatic cyst growth. Percutaneous cyst puncture and drainage or surgical therapy can be considered if a slight improvement with antibiotic therapy alone or exclusion of surrounding organs is observed. Further, attention is needed to avoid potential recurrence.     

Mesenteric chylous (lymph-containing) cyst

Mesenteric cysts are uncommon entities and chyle (lymph)-containing cysts are the rarest of this group. A case report of a chylous cyst with CT demonstrating unique fat and soft tissue fluidfluid levels is presented.     

Role of ultrasound in the diagnosis of abdominal hydatid disease

Experience with the use of ultrasound for investigating hydatid disease of the abdomen is reported. The presence of daughter cysts within the parent cyst gives a pathognomonic sonographic picture, whether the cyst is single or multiple. The presence of single cysts without daughter cysts is still a diagnostic problem, unless calcification is seen. Associated secondary infection changes the picture to one of a nonspecific abscess, and only the presence of additional cysts can give a clue about the etiology.     

Spontaneously ruptured hepatic cyst treated with laparoscopic deroofing and cystobiliary communication closure: A case report

The rupture of a nonparasitic hepatic cyst with biliary communication is rare. We report the case of a patient with a hepatic cyst with biliary communication that spontaneously ruptured and was successfully treated by laparoscopic deroofing and closure of the communication. A 61‐year‐old woman presented at our hospital with a chief complaint of right upper abdominal pain. Enhanced abdominal CT showed a collapsed hepatic cyst and fluid collection. Drip infusion CT cholangiography showed contrast medium pooling in the collapsed cyst. Therefore, hepatic cyst rupture with biliary communication was diagnosed, and laparoscopic deroofing and closure of the communication were performed. The postoperative course was uneventful, and the patient was discharged on postoperative day 6. In cases of hepatic cyst rupture, even in the presence of biliary communication, laparoscopic deroofing and closure of the communication should be recommended as the first‐choice treatment.     

Retroperitoneal Bronchogenic Cyst Resected by Single-Incision Laparoscopic Surgery in an Adolescent Female: A Case Report

A 16-y-old Japanese female was referred to our hospital with a suspicion of infected retroperitoneal cyst. Abdominal CT MRI revealed a 38-mm diameter retroperitoneal cyst under the left diaphragm. Because a retroperitoneal bronchogenic cyst was suspected, total resection was planned. In addition, preoperative 3D reconstruction using multidetector CT provided a detailed location of the lesion. Based on the anatomical position, we decided that single-incision laparoscopic surgery with an anterior approach through the umbilicus would be the optimal choice. The lesion was completely resected without intraoperative complications. Histopathological examination confirmed the diagnosis of bronchogenic cyst. Postoperatively, the surgical wound became completely unnoticeable, and there was no incisional hernia or cyst recurrence at the 2-y follow-up.     

椎管内囊肿的手术治疗

目的探讨椎管内囊肿的手术治疗疗效。方法 2006年5月-2009年12月对30例患者的临床表现、影像学和治疗情况进行回顾性分析。结果 30例均行手术治疗,3例为椎管内单侧硬膜下髓外囊肿,3例为脑脊膜囊肿,12例为髓外硬脊膜下囊肿,9例为神经根袖套部囊肿（Tarlov囊肿）,3例为脊管内肠源性囊肿。术后21例症状消失;9例好转,其中3例术后发生脑脊液漏,伤口二次缝合未成功,后经内引流后切口愈合。结论椎管内囊肿的临床表现及体征复杂,不典型,与椎管内肿瘤及椎间盘突出症的临床表现和体征相似;对症状及体征明显者宜施行手术治疗,手术治疗效果较满意。     

Laparoscopy-assisted spleen-preserving pancreatic resection for epidermoid cyst in an intrapancreatic accessory spleen

A rare case of an epidermoid cyst originating in an intrapancreatic accessory spleen in a 50-year-old Japanese female is reported. A hypoechoic cystic tumor was detected incidentally by abdominal ultrasonography. It appeared to be a single cyst in the pancreatic tail with a contrasted mass lesion beside it. Laparoscopy-assisted spleen-preserving pancreatic tail resection was performed. Microscopic examination revealed that the cyst was surrounded by fibrous tissue and a thin layer of splenic tissue, adjacent to normal pancreatic parenchyma. The inner surface of the cyst was lined with non-keratinizing squamous epithelium. The diagnosis of an epidermoid cyst occurring in an intrapancreatic accessory spleen was confirmed. Laparoscopy-assisted spleen-preserving pancreatic resection is a safe and effective procedure for benign or low-grade malignant cystic diseases in the pancreas.     

经腹腔镜行卵巢冠囊肿剥除的临床效果观察

目的评价经腹腔镜行卵巢囊肿剥除手术的可行性,总结微创治疗卵巢冠囊肿的外科策略。方法对48例行腹腔镜手术剥除卵巢冠囊肿的患者进行回顾性分析,与100例经开腹手术行卵巢囊肿剥除术的患者进行比较,对手术时间、出血量、术后自肛门排气时间、住院时间、术后下床时间、术后并发症率、镇痛药使用等指标进行对比。结果腹腔镜组住院时间较短、出血量较少、术后肛门排气、术后并发症f发生率低和镇痛药物使用少,但手术费用偏高。结论腹腔镜行卵巢冠囊肿剥除是安全可行的治疗手段。     

椎管内硬膜外囊肿：１例报道并文献复习

目的：分析椎管内硬膜外囊肿的影像学表现。材料与方法：报道1例在CT及MRI检查,手术病理证实的管内硬膜外囊肿,结合文献分析其发生、发展及临床表现。结果：CT及MRI均显示椎管背侧的囊肿,MRI能更好的显示囊肿的大小及其与硬膜囊的关系。结论：MRI是诊断椎管内硬膜外囊肿的最佳影像学手段。     

Transient fetal sternal dermal cyst: report of 2 cases and literature review.

OBJECTIVE: The purpose of this series was to describe the prenatal diagnosis and pregnancy outcome of fetuses affected by a transient idiopathic fetal sternal cyst. METHODS: Two fetuses had the diagnosis of an isolated presternal cyst at routine sonography at 15 weeks. A follow-up sonographic examination was done, and the neonates were examined after birth. RESULTS: In both cases, the cyst disappeared at 20 weeks' gestation, and both fetuses had only a small dimple at the location of the cyst. CONCLUSIONS: An isolated presternal cyst is an extremely rare finding. It should be followed sonographically, and if it disappears within a few weeks, the diagnosis of a dermal inclusion cyst should be suspected. Parents can be informed to anticipate a small depression on the neonate's chest.     

Complete laparoscopic choledochal cyst excision and hepaticojejunostomy with laparoscopic Roux-Y reconstruction using a 5-mm stapler: A case of a 2-month-old infant

Laparoscopic choledochal cyst excision and hepaticojejunostomy for choledochal in children is performed only at particular institutions because of the technical difficulty. Although choledochal cyst excision and hepaticojejunostomy are feasible, the small working space of infants makes intraabdominal Roux-Y reconstruction technically challenging. A 2-month-old girl diagnosed with a choledochal cyst underwent complete laparoscopic choledochal cyst excision and hepaticojejunostomy, including intraabdominal Roux-Y reconstruction with a 5-mm stapler. After cyst excision, Roux-Y reconstruction was performed in the intraabdominal cavity. Jejunojejunostomy was performed in a side-to-side fashion using a 5-mm stapler, and the entry hole was closed laparoscopically by hand-sewing, along with the mesentery defect. All procedures were performed by laparoscopic surgery. The postoperative course was uneventful, and the patient showed a quick recovery. Using small-diameter instruments, completely laparoscopic procedures for choledochal cyst are feasible.     

Case report: Laparoscopic excision of urachal cyst in a child

Summary

A urachal cyst in a 13-year-old boy presented with symptoms of abdominal pain and microscopic haematuria was removed laparoscopically. The case is presented and the procedure is discussed.     

超声包裹征预测附件囊性包块蒂扭转的价值

目的探讨超声"包裹征"预测附件囊性包块蒂扭转的应用价值。方法回顾性分析193例因急性下腹痛就诊且超声检查存在附件囊性包块女性患者的超声图像,以手术结果为金标准确定附件扭转组131例,非扭转组62例,比较两组间超声包裹征的出现率,计算包裹征预测附件囊性包块蒂扭转的诊断效能。结果 (1)包裹征对应病理表现为扭转后输卵管及囊壁组织的广泛梗死水肿,半包绕扭转蒂部远端的囊肿;(2)扭转组131例中,出现包裹征共36例(27.5%),非扭转组中62例中出现1例(1.6%)包裹征,两组间差异具有统计学意义(P<0.001)。包裹征诊断附件囊性包块蒂扭转灵敏度、特异度和准确度分别为27.5%、98.4%、50.3%。当囊性包块最大长径<75.5mm时,包裹征诊断附件囊肿蒂扭转灵敏度、特异度和准确度分别为51.9%、97.6%、71.6%。结论超声包裹征预测附件囊性包块蒂扭转中具有高特异度。对于因下腹痛来诊女性患者,当合并包裹征时,应敢于提出疑似扭转的诊断。     

高频超声诊断表皮样囊肿的价值

目的探讨高频超声诊断表皮样囊肿的价值。方法回顾性分析63例经手术和病理证实的表皮样囊肿患者的超声表现。结果本组63例患者共计66个病灶,其超声表现可分为3型,分别为均质回声型18个、不均质回声型40个、混合回声型8个。彩色多普勒显示所有病灶内均未见血流信号,4个混合回声型病灶在囊周可见较丰富点、条状血流信号。结论高频超声对诊断表皮样囊肿具有重要价值。     

Asymmetric Ventriculomegaly,Interhemispheric Cyst,and Dysgenesis of the Corpus Callosum (AVID)

A series of 20 cases from 2 academic institutions is presented with a characteristic imaging triad of asymmetric ventriculomegaly, a large interhemispheric cyst, and partial or complete agenesis of the corpus callosum. Most cases were initially referred as aqueduct stenosis and hydrocephalus or focal porencephaly. We describe the imaging findings that identify an abnormal or absent corpus callosum associated with a type 1 interhemispheric cyst in fetuses initially thought to have hydrocephalus attributable to aqueductal stenosis. We suggest that the acronym AVID (asymmetric ventriculomegaly, interhemispheric cyst, and dysgenesis of the corpus callosum) may be useful in recognition of these cases. All cases presented with markedly asymmetric ventriculomegaly on initial sonography, with progressive hydrocephalus throughout gestation. Fetal magnetic resonance imaging was performed in 15 of 20 cases. Thirteen of 20 cases were identified in male fetuses. Associated fetal and postnatal abnormalities are also reported. Technological improvements in sonography and fetal magnetic resonance imaging allow improved characterization of associated intracranial anomalies in the setting of hydrocephalus. Accurate diagnosis can aid parental counseling, especially because isolated aqueductal stenosis suggests a better prognosis than hydrocephalus with anomalies. Markedly asymmetric ventriculomegaly in this series was the key to excluding isolated aqueductal stenosis and was associated with callosal malformation with a type 1a interhemispheric cyst.     

脾囊肿的诊断与治疗（附7例报告）

目的,探讨脾囊肿的诊断与治疗方法。方法：结合部分国内外资料,分析讨论7例脾囊肿病例。结果：7例均手术治疗,行全脾切除4例,其中1例保留了副脾,1例行脾片移植,行半脾及囊肿切除3例。本组均治愈。结论：脾囊肿少见,目前病因仍未完全明了,其诊断主要依靠病史,B超及CT检查,本病以手术治疗为主。手术方式应根据囊肿的部位,大小,性质、分别选择全脾切除,半脾或脾部分切除。     

小儿甲状舌管囊肿的超声诊断价值

目的 探讨甲状舌管囊肿的声像图特征及超声诊断价值。方法 回顾性分析64例超声诊断为甲状舌管囊肿的声像图特征，并与手术结果对照。结果 64例中，经手术病理证实为甲状舌管囊肿62例。超声明确显示甲状舌管31例，显示肿块与舌骨直接关系45例。超声诊断符合率96.9%(62/64)。结论 超声诊断甲状舌管囊肿具有很高的临床价值，尤其是当发现残留甲状舌管时，即可确诊。     

The management of ovarian cysts by sono-guided transvaginal cyst aspiration

Nineteen transvaginal, sono-guided ovarian cyst punctures were performed in 18 patients. These patients, who were high surgical risks, were diagnosed to possess benign ovarian tumors as revealed with sonography. Aspiration curettage of the inner surface of the cyst present during aspiration was also performed to facilitate cytologic diagnosis. The recurrence rate was 11.1%. Sono-guided transvaginal cyst aspiration has been demonstrated here to be the treatment of choice for dealing with an ovarian cyst in patients at high surgical risk. © 1993 John Wiley & Sons, Inc.