Imaging of Cystic and Cyst-like Lesions of the Mediastinum with Pathologic Correlation

Abstract

<jats:p>Cystic masses of the mediastinum are a heterogenous group of asymptomatic or symptomatic, congenital, infectious, or neoplastic lesions. For early and correct diagnosis, evaluation, and optimal patient management of cystic mediastinal masses in infants, children, or adults imaging plays an important role. A non-invasive and sensitive imaging modality is an efficient and cost-effective tool. Multidetector computed tomography (MDTC) with volumetric acquisition provides fast acquisition of high resolution images and multiplanar reconstruction. Both 2D and 3D imaging in mediastinal imaging help in surgical planning and assessing resectability of mediastinal lesions. MR imaging has many advantages over other modalities for detecting and identifying cystic, or fluid-filled mediastinal masses, because of its intrinsic high soft tissue contrast and direct multiplanar imaging capabilities. However, histological tissue analysis may be required to differentiate a cystic lesion from other cyst-like or low-attenuation lesions.</jats:p>

Cystic Lesions of the Mediastinum

“…Characteristically, lymphangiomas do not result in significant compression or displacement of adjacent structures, but rather envelop these [10].…”

“…These lesions demonstrate a combination of tissue elements, including fatty and cystic components, along with soft tissue and foci of calcification (figures 8 and 9). Rarely, a mature teratoma may rupture into the pleura, lung or pericardial spaced [1,10].…”

“…The mediastinal cyst usually present signal intensity isointense to cerebrospinal fluid, low on T1WI and high on T2WI (figure 12). In case of rich mucous or proteinaceous content the cyst me present high signal on T1WI[10].Intrathoracic MeningoceleA meningocele is an abnormal herniation of the meninges through a neural foramina or a bony defect in a vertebral body with most occurring (80%) in the dorsal aspect of the lumbosacral spine. Rarely, an anterior spinal meningocele develops on the anterior aspect of the thoracic or lumbar spine, with those in the thoracic region presenting as a posterior mediastinal mass.These frequently occur as a complication of generalized mesenchymal dysplasia in particular secondary to neurofibromatosis type 1 (NF-1) in as much as 85%.…”

Application of endoscopic ultrasound‐guided‐fine needle aspiration combined with cyst fluid analysis for the diagnosis of mediastinal cystic lesions

“…Cystic masses of the mediastinum are a heterogenous group of lesions including congenital abnormalities, infection, and neoplasms, and account for 15–20% of all mediastinal masses . Congenital cysts include foregut duplication cysts, cysts of the thymus, pericardial cysts, and diverticula.…”

“…On CT, the cystic lesion shows a well‐defined, thin, smooth wall with homogeneous attenuation. On MRI, foregut cysts usually present with high signal intensity on T2‐weighted and T1‐weighted variables . However, for cysts with thick proteinaceous contents, such images could lead to a 30–80% chance of misdiagnosis as solid mass lesions .…”