Nishizaki K, Ohno K, Hatanaka N, Yamamoto S, Kuwata K, Kobayashi Y
Department of Surgery, Osaka Kosei-Nenkin Hospital, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1996 Oct;44(10):1871-6.
The patient, a 55-year-old asymptomatic man, was referred to our hospital in October 1995 for further investigation of a chest ++roentogenographic abnormality found during a "physical check-up". His chest X-ray showed a round shadow over the hilus of the left lung. Computed tomography revealed a homogeneous, low density mass bordering the esophagus, vertebral column, left lower pulmonary vein and descending aorta. Roentogenography after swallowing barium sulfate showed that the esophagus was compressed and displaced to the right in the anterior direction. Endoscopic ultrasound scan demonstrated a cystic mass. The preoperative findings were suggestive of an esophageal cyst or a thoracic duct cyst. On December 12, 1995, the patient was operated on. The mass was 2 x 3 x 6 cm in size, and was easily separated from the left pulmonary vein, esophagus and vertebral column by blunt and sharp dissection, but it was strongly adhered to the aorta. The wall of the cyst was incised and a chylous fluid was found inside. The mass was diagnosed as a thoracic duct cyst and was removed after clipping and cutting the thoracic duct above and below the cyst. Histopathological features of the wall of the cyst was that the luminal surface was lined by a monolayer of flat endothelium and composed of loose fibrous tissue with scattered bundles of smooth muscle. It differed from that of veins. The postoperative course was uneventful and he was discharged on the 12th postoperative day. Mediastinal thoracic duct cysts are rare and only 25 operated cases have been reported in the literature. We review and discuss these cases.
患者为一名55岁无症状男性，于1995年10月因在“体检”时发现胸部X线异常而转诊至我院作进一步检查。其胸部X线显示左肺门上方有一圆形阴影。计算机断层扫描显示一个边界清晰的均匀低密度肿块，与食管、脊柱、左下肺静脉和降主动脉相邻。吞钡后X线检查显示食管向前方受压并向右移位。内镜超声扫描显示为囊性肿块。术前检查结果提示为食管囊肿或胸导管囊肿。1995年12月12日，患者接受手术。肿块大小为2×3×6cm，通过钝性和锐性分离很容易与左肺静脉、食管和脊柱分离，但与主动脉紧密粘连。切开囊肿壁，发现内部有乳糜液。肿块被诊断为胸导管囊肿，并在囊肿上下夹闭和切断胸导管后将其切除。囊肿壁的组织病理学特征为管腔表面衬有单层扁平内皮，由疏松纤维组织组成，有散在的平滑肌束。与静脉不同。术后过程顺利，患者于术后第12天出院。纵隔胸导管囊肿罕见，文献中仅报道了25例手术病例。我们对这些病例进行回顾和讨论。
