Mediastinal Extension of a Pancreatic Pseudocyst: A Rare Intrathoracic Complication of Pancreatitis

Pancreatic pseudocysts are a common complication of pancreatitis. However, mediastinal extension of a pseudocyst is rare and often presents with atypical symptoms. We present a case of mediastinal extension of a pancreatic pseudocyst in a 56-year-old woman with a history of alcohol-related chronic pancreatitis, who presented with acute on chronic epigastric abdominal pain and atypical chest pain. Serum lipase was elevated, and imaging by contrast-enhanced computed tomography (CT) demonstrated a paraesophageal fluid collection. This collection was continuous with a peripancreatic pseudocyst and extended into the posterior mediastinum via the esophageal hiatus. Mediastinal extension of a pancreatic pseudocyst was confirmed by magnetic resonance imaging (MRI). The patient was managed conservatively in the hospital with parenteral nutrition therapy, pain control, and close imaging observation. The patient was discharged home to continue conservative management and close imaging follow-up. An initial follow-up CT examination 8 weeks after discharge revealed interval decrease in the posterior mediastinal collection but also interval development of loculated left pleural and pericardial effusions.

Rare giant zenker’s diverticulum with mediastinal extension

Zenker’s Diverticulum (ZD) is a herniation of the posterior pharyngeal wall between the inferior pharyngeal constrictor and the cricopharyngeus muscle through a natural weakness [1]. The main clinical presentation is progressive solid food and pill dysphagia, with subsequent weight loss, halitosis, and regurgitation, complicated by the occurrence of several aspiration and recurrent pneumonia when extended into the chest [2,3]. Indeed, only rare few cases of massive mediastinal extension were reported in the literature [3].

Case Report: Modified Thoracoscopic-Assisted Cervical Resection for Retrosternal Goiter

Introduction: The treatment of choice for retrosternal goiters (RSG) is surgical resection to relieve symptoms and rule out malignancy. Although the majority of RSG can be removed by a cervical approach only, an extracervical approach (e.g., sternotomy, thoracotomy or thoracoscopy) may be required. Herein, we describe a refined thoracoscopic-assisted cervical two-team RSG resection without thoracoscopic mediastinal dissection.Technique: A 57-year-old man presented with a large RSG with posterior mediastinal extension (PME) and extensive peritumoral vascularization. Due to its extension below the aortic arch and its small connection with the right thyroid lobe, a combined cervical and thoracoscopic approach was intended. The endocrine surgery unit performed the cervical mobilization of the right thyroid lobe, while the thoracic surgery unit gently pushed the mediastinal tumor through the thoracic inlet without performing mediastinal dissection. This allowed a safe visualization of the inserting vessels by the endocrine surgery team at the neck, followed by a stepwise division of the vessels and resection of the retrosternal nodule through the cervical access.Comment: The described approach is indicated for RSG with posterior mediastinal extension, anteroposterior dimension smaller than the thoracic inlet and inaccessibility from a cervical approach only. This minimally invasive approach is associated with a faster recovery, decreased morbidity and postoperative pain, shorter hospital stay and better cosmetic results.

EXTENSIVE CERVICAL NECROTISING FASCIITIS WITH MEDIASTINITIS IN A COVID-19 POSITIVE PATIENT: A CASE REPORT

Necrotising fasciitis is a rapidly progressing soft tissue infection associated with significant morbidity and mortality. We present a case of cervical necrotising fasciitis with mediastinal extension in a diabetic young male who was COVID-19 positive. He presented with a five-day history of left-sided neck swelling which was fluctuant, red and painful. Subsequent debridement and management of the wound were complicated by the comorbid SARS-CoV2 infection due to potential need for proning. This case highlights the complex interplay between the management of two significant conditions; the surgical approach to necrotising fasciitis and the concern of deterioration due to COVID-19.

Giant Cystic Pancreatic Lymphangioma with Mediastinal Extension: A Case Report and Review of the Literature

Lymphangioma is an infrequent benign tumour that is formed usually from a congenital malformation of the lymphatic ducts causing lymphangiectasis. The abdominal location represents 1-5%, with dominance in the mesentery and retroperitoneum, however, the pancreatic location is very rare having described less than 100 cases published worldwide. The clinical symptoms of the lymphangiomas are non-specific and depend of the tumour’s size and location. Here we present a clinical case of a pancreatic lymphangioma with mediastinal extension who was treated with a complete resection and this case shows that the diagnosis of cystic pancreatic lymphangioma must be taken as a differential diagnosis of pancreatic cystic lesions.