MyMedR

Fulltext An unusual injury to the mediastinum--case report

Visvanathan R

Singapore Med J, 1992 Dec;33(6):639-40.

A six-year-old boy sustained an accidental penetrating missile injury to his chest. Imaging studies revealed a metallic foreign body lodged between the pulmonary infundibulum and the right atrium of the heart. No cardiovascular compromise was produced. Surgical exploration was not required. The foreign body remained stable and non-migratory over a 16-month follow-up period.

Matched MeSH terms: Mediastinum/injuries*; Mediastinum/radiography

Case report: robotic thoracic surgery of posterior mediastinal mass

Adli Azam MR, Shahril K, Aneez Ahmed DB

Med J Malaysia, 2020 07;75(4):428-429.

PMID: 32724008

We report a 39-year-old male with accidental findings of posterior mediastinum mass at right superior aspects, located at T2 with close proximity to trachea, superior vena cava, azygus vein, right subclavian artery and oesophagus. Apart from intermittent right shoulder pain, there was no other significant symptom. He opted for conservative management initially, given the benign nature and proximity to important structures. We postulated that robotic approach will be of advantage for this particular case which was successfully performed with uneventful recovery. This case illustrated the advantages of robotic-assisted surgery, compared to conventional VATS in otherwise potentially difficult case to undertake.

Matched MeSH terms: Mediastinum/physiopathology*; Mediastinum/surgery*

The diagnosis of lung cancer in the era of interventional pulmonology

Liam CK, Lee P, Yu CJ, Bai C, Yasufuku K

Int J Tuberc Lung Dis, 2021 01 01;25(1):6-15.

PMID: 33384039 DOI: 10.5588/ijtld.20.0588

Advances in bronchoscopic and other interventional pulmonology technologies have expanded the sampling procedures pulmonologist can use to diagnose lung cancer and accurately stage the mediastinum. Among the modalities available to the interventional pulmonologist are endobronchial ultrasound-guided transbronchial needles aspiration (EBUS-TBNA) and transoesophageal bronchoscopic ultrasound-guided fine-needle aspiration (EUS-B-FNA) for sampling peribronchial/perioesophageal central lesions and for mediastinal lymph node staging, as well as navigational bronchoscopy and radial probe endobronchial ultrasound (RP-EBUS) for the diagnosis of peripheral lung cancer. The role of the interventional pulmonologist in this setting is to apply these procedures based on the correct interpretation of clinical and radiological findings in order to maximise the chances of achieving the diagnosis and obtaining sufficient tissue for molecular biomarker testing to guide targeted therapies for advanced non-small cell lung cancer. The safest and the highest diagnosis-yielding modality should be chosen to avoid a repeat sampling procedure if the first one is non-diagnostic. The choice of site and biopsy modality are influenced by tumour location, patient comorbidities, availability of equipment and local expertise. This review provides a concise state-of-the art account of the interventional pulmonology procedures in the diagnosis and staging of lung cancer.

Matched MeSH terms: Mediastinum/pathology

Fulltext Transcervical thyroidectomy for huge posterior mediastinal goitre: a challenging case

Khandasamy, Y., Nani Harlina, M.L., Saladina, J.J., Rohaizak, M.

Journal of Surgical Academia, 2015;5(1):82-84.

MyJurnal

The decision for median sternotomy for retrosternal goiter is complex and proper consensus are lacking. Generally, it is based on clinical, radiological and intraoperative assessment. Among the few known features include primary mediastinal goiter, posterior mediastinal goiter and recurrent retrosternal goiter. We present a patient with posterior mediastinal, secondary goiter that extended until the tracheal bifurcation. The goiter was removed successfully via a low cervical incision and this was achieved by dissecting along the anatomical plane close to the thyroid capsule using blunt dissection with fingers. It is possible for these kinds of high risk retrosternal goitres to be safely removed without the need for thoracotomy when the surgery was performed along the proper plane.

Matched MeSH terms: Mediastinum

A dedifferentiated large posterior mediastinal liposarcoma - An incidental finding successfully resected

Narasimman S, Jasjit SN, Navarasi SR, Premnath N

Med J Malaysia, 2016 08;71(4):201-202.

PMID: 27770120

This is a case of a posterior mediastinal mass in an asymptomatic gentleman, which was resected successfully and he has been disease free for more than a year of follow up. The histopathology findings happen to be a rare occurrence.

Matched MeSH terms: Mediastinum

Fulltext Early experience of endobronchial ultrasound-guided transbronchial nodal cryobiopsy: a case series from Sabah, Malaysia

Ramarmuty HY, Huan NC, Nyanti LE, Khoo TS, Renganathan T, Manoh AZ, et al.

Ther Adv Respir Dis, 2024;18:17534666241231122.

PMID: 38357899 DOI: 10.1177/17534666241231122

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an established minimally invasive method for the diagnosis of benign and malignant conditions. Continuous efforts are underway to improve the material adequacy of EBUS-TBNA, including the introduction of a new technique called EBUS-guided transbronchial nodal cryobiopsy (EBUS-TBNC). This method allows for the retrieval of larger and well-preserved histologic samples from the mediastinum. We present a case series of four patients who underwent combined EBUS-TBNA and EBUS-TBNC procedures in our centre. All procedures were performed under general anaesthesia using a convex probe EBUS scope (Pentax EB-1970UK). Two patients were diagnosed with malignancy and two with benign disorders (silicosis and tuberculosis). In the malignant cases, both EBUS-TBNA/cell block and cryobiopsy provided a diagnosis but cryobiopsy yielded more material for ancillary tests in one patient. However, in the benign cases, there was discordance between EBUS-TBNA/cell block and cryobiopsy. Only cryobiopsy detected granuloma in the patient with TB (tuberculosis), and in the patient with silicosis, TBNC provided a better overall histological evaluation, leading to a definitive diagnosis. No complications were observed. This case series supports the potential diagnostic value of combining EBUS-TBNA and EBUS-TBNC, particularly in benign mediastinal lesions (granulomatous diseases), and in cases requiring additional molecular tests in cancer diagnosis.

Matched MeSH terms: Mediastinum/pathology

Fulltext Primary mediastinal myxoid liposarcoma

Suzana, A.H., Hasyma, A.H., Suraini, M.S., Saiful Nizam, A.R.

Malaysian Journal of Medicine and Health Sciences, 2013;9(2):77-80.

MyJurnal

In this study, we report an extremely rare case of liposarcoma which arises primarily in mediastinum. The patient appeared to have progressive dyspnoea and prolonged cough for a duration of one year. Chest radiograph and Computed Tomography (CT) of the thorax revealed a large right mediastinal mass with fatty component. It was confirmed to be primary liposarcoma on histopathological examination.

Matched MeSH terms: Mediastinum

Fulltext Dysphagia lusoria: a case report

Nik Qisti, F., Shahrun Niza, A.S., Razrim, R.

International Medical Journal Malaysia, 2016;15(2):73-76.

MyJurnal

Aberrant right subclavian artery is a rare cause of dysphagia. This is a congenital anomaly with the right
subclavian artery originating from the dorsal part of the aortic arch and coursing through the mediastinum
between the esophagus and the vertebral column. We report a case of a patient with chronic dysphagia
caused by this condition. We further discuss the case with regards to its clinical features and options of
management.

Matched MeSH terms: Mediastinum

Mediastinal irradiation and its effect on the cardiovascular system

Tang D, Peng EW, Giri D, Chowdhary M, Sarkar P

Br J Hosp Med (Lond), 2009 Apr;70(4):222-4.

PMID: 19357601 DOI: 10.12968/hmed.2009.70.4.41626

Mediastinal irradiation for various malignancies can cause radiation injury to mediastinal structures, most importantly the cardiovascular system. This article reviews the effect of radiation on cardiovascular structures and the manifestations of various radiation-induced heart diseases.

Matched MeSH terms: Mediastinum/blood supply; Mediastinum/radiation effects*

Fulltext Ultrasound guided percutaneous biopsies of suspected mediastinal lesions

Samad SA, Sharifah NA, Zulfiqar MA, Maimunah A, Yahya A, Zainudin W

Med J Malaysia, 1993 Dec;48(4):421-6.

PMID: 8183166

Realtime ultrasonography with general purpose sector transducer was used to guide 87 percutaneous biopsies on 82 patients with lesions suspected to be mediastinal masses on plain chest radiographs. In seven patients who had dyspnea the biopsies were done in erect or semi-erect sitting positions. Definitive diagnosis was obtained from 66 lesions (80.5%) where 46 (70.0%) were mediastinal and the remaining 20 lesions (30.0%) arising from the lung. Of the 46 mediastinal lesions where specific diagnosis were made, 42 (91.0%) were anterior and four (0.9%) posterior mediastinal lesions. The majority of these anterior mediastinal masses were lymphomatous nodes followed by germ cell tumours whereas all four posterior mediastinal masses were neurogenic. Of the lung lesions, 19 were primary malignancies. The remaining lung lesion which was located posteriorly was cryptococcus infection. One patient developed massive hemothorax, but subsequently recovered. No significant complications were encountered in the remaining patients. Surgery was carried on 11 patients. There is correlation between definitive diagnosis from percutaneous biopsy and final diagnosis after surgery in 80% of patients. It is proposed that all percutaneous biopsies for thoracic masses which abut the chest wall and cause mediastinal widening on a plain chest radiograph be guided by ultrasound. It can be effectively accomplished with ease and safety even without the use of dedicated biopsy ultrasound probes or biopsy attachments, and on patients in erect or semi-erect positions.

Matched MeSH terms: Mediastinum/pathology*; Mediastinum/ultrasonography

Fulltext Hoarseness as the sole symptom of an impending thoracic aneurysm rupture?

Jaafar R, Mohamad I

Malays Fam Physician, 2014;9(1):25-7.

PMID: 25606294 MyJurnal

Unilateral vocal cord palsy secondary to thoracic aortic aneurysm is a rare occurrence. Direct compression of the enlarging thoracic aneurysm on the left recurrent laryngeal nerve causes neuronal injury of the nerve, which is manifested as hoarseness. We present a rare case of unilateral vocal cord palsy in a 60-year-old healthy gentleman caused by a large thoracic aortic aneurysm. This rare presentation, with a serious underlying pathology might be misdiagnosed or delayed. Therefore, it is important for us to have high index of suspicion in cases with a rare presentation such as this.

Matched MeSH terms: Mediastinum

Fulltext Pleuritic chest pain and fever: An unusual presentation of aortic dissection

Mohamed-Yassin MS, Baharudin N, Ramli AS, Hashim H

Malays Fam Physician, 2019;14(1):47-52.

PMID: 31289633

It remains a challenge to diagnose aortic dissection in primary care, as classic clinical features are not always present. This case describes an atypical presentation of aortic dissection, in which the patient walked in with pleuritic central chest pain associated with a fever and elevated C-reactive protein. Classic features of tearing pain, pulse differentials, and a widened mediastinum on chest X-ray were absent. This unusual presentation highlights the need for a heightened level of clinical suspicion for aortic dissection in the absence of classic features. The case is discussed with reference to the literature on the sensitivity and specificity of the classic signs and symptoms of aortic dissection. A combination of the aortic dissection detection risk score (ADD-RS) and D-dimer test is helpful in ruling out this frequently lethal condition.

Matched MeSH terms: Mediastinum

Fulltext Spontaneous pneumothorax and pneumomediastinum after a trivial injury: a case report

Ahmad Faizal Rakawi, Abdul Aziz Marwan, Ummi Nadira Daut

Malaysian Journal of Medicine and Health Sciences, 2020;16(108):84-86.

MyJurnal

Spontaneous pneumothorax and pneumomediastinum is defined as presence of free air or gas in the pleural cav- ity and mediastinal structures respectively. Spontaneous pneumothorax seems to be associated with anatomical abnormalities such as subpleural blebs or bullae, however not for spontaneous pneumomediastinum which may developed without an apparent precipitating cause. Both usually may occur in young healthy adults without serious underlying lung disease. We report a case of spontaneous pneumothorax and pneumomediastinum after a trivial injury. He was initially presented with dyspnea after two weeks of initial trivial trauma. Chest radiograph showed left apical pneumothorax with pneumomediastinum with no evidence of rib fracture. His condition was deemed non-traumatic by surgical colleague, thus admitted to medical ward for observation and eventually discharged well.

Matched MeSH terms: Mediastinum

Fulltext Benign mature cystic teratoma masquerading as recurrent pneumonia in a young adult

Azhar, A.H., Ziyadi, G., Rashidi, A., Rahman, M.N.G.

Journal of Surgical Academia, 2012;2(1):56-59.

MyJurnal

Mediastinal mature cycstic teratomas are rare germ cell tumors most commonly found in the anterior mediastinum, and constitute about 3-12% of all mediastinal tumors. They grow slowly and are usually diagnosed incidentally. This is a rare presentation of a young lady with mediastinal mature cystic teratoma (dermoid cyst) presenting with chronic cough and haemoptysis.

Matched MeSH terms: Mediastinum

Fulltext A new genus and two new species of Southeast Asian Bidessini as well as new synonyms for Oceanian species (Coleoptera, Dytiscidae)

Balke M, Bergsten J, Wang LJ, Hendrich L

Zookeys, 2017.

PMID: 28325968 DOI: 10.3897/zookeys.647.11231

Rompindessus jenisi Balke, Bergsten & Hendrich, gen. n. et sp. n. is described from near Rompin village in West Malaysia. The new genus is characterized by the presence of an occipital line and basal pronotal striae, the presence of a thick anterior bead on clypeus and two-segmented parameres as well as by the absence of basal elytral striae, the absence of sutural line on elytron, the absence of basal epipleural transverse carina, and the absence of longitudinal elytral carina. Moreover, male pro- and mesotarsus appear stout, and distinctly dilated laterally; the pronotum is comparably long and parallel-sided and the colour of beetle conspicuous dark orange. Leiodytes kualalipis Balke, Wang, Bergsten & Hendrich, sp. n. is described from West Malaysia (Pahang) and South Vietnam (Cat Tien). It is well characterized by its large size, elongate body and the form of the median lobe. Limbodessus fijiensis (J. Balfour-Browne, 1944), comb. n. described from Fiji is a new synonym of Limbodessus curviplicatus (Zimmermann, 1927) described from Samoa.

Matched MeSH terms: Mediastinum

Fulltext A Rare Presentation of Anterior Mediastinal Teratoma Mimicking Valvular Heart Disease with A Systolic Murmur

Lip HTC, Huei TJ, Wahid AA, Vendargon SJ

Eurasian J Med, 2018 Jun;50(2):134-136.

PMID: 30002584 DOI: 10.5152/eurasianjmed.2018.17388

Extrinsic pulmonary artery stenosis caused by anterior mediastinum teratoma presenting with an ejection systolic murmur is a rare phenomenon. Till date, 15 cases have been reported (inclusive of this case) in the English literatures. Herein we report a 20 year old female with extrinsic pulmonary artery stenosis because of compression by an anterior mediastinal teratoma with a loud ejection systolic murmur. The case report aims to highlight the awareness of such rare presentation of anterior mediastinal teratomas that may mimic congenital valvular heart diseases among clinicians.

Matched MeSH terms: Mediastinum

Fulltext Solitary fibrous tumor of the paranasal sinus presenting as an antrochoanal polyp

Mansharan Kaur Chainchel Singh

Malaysian Journal of Medical Research, 2018;2(2):91-94.

MyJurnal

Solitary fibrous tumours (SFTs) are unusual mesenchymal tumours that were first described as primary spindle-cell neoplasms of the pleura. These tumours have been described in many other locations, including the urogenital system, orbit, mediastinum, and upper respiratory tract. These tumours are generally benign in nature, however some of them can be locally invasive and have the potential to be malignant. Although about 12%-15% of them occur in the head and neck area, SFT of the nasal cavity and paranasal sinuses are extremely rare. We present a case of a solitary fibrous tumour arising from the right maxillary sinus in a 50 year old Chinese man.

Matched MeSH terms: Mediastinum

Fulltext Growing teratoma syndrome of mediastinal nonseminomatous germ cell tumor

Diong NC, Dharmaraj B, Joseph CT, Sathiamurthy N

Ann Thorac Med, 2020 01 02;15(1):38-40.

PMID: 32002046 DOI: 10.4103/atm.ATM_296_19

Mediastinal nonseminomatous germ cell tumor (NSGCT) is rare. NSGCT shows excellent response to cisplatin-based chemotherapy. However, some tumors continue to enlarge despite normal tumor markers after chemotherapy, a rare condition called growing teratoma syndrome (GTS). Recognition of this condition is imperative for prompt surgical resection to prevent further cardiopulmonary compression and to improve survival. Multidisciplinary team meeting is important for perioperative preparation and care to improve the outcome of this high-risk surgery. Here, we report two cases of mediastinal GTS and underwent surgical resection, of which one died of pericardial decompression syndrome and the other is well.

Matched MeSH terms: Mediastinum

Fulltext Transbronchial lymph node forceps biopsy as a novel tool in diagnosis of mediastinal lymphadenopathy: a pilot study

Al-Halfawy A, Hussein S, Ashur W, El-Hendawi A, Hussein S

J Cardiothorac Surg, 2024 Feb 07;19(1):69.

PMID: 38326810 DOI: 10.1186/s13019-024-02560-x

BACKGROUND: Differential diagnosis of mediastinal lymphadenopathy is an issue of debate. Lymph nodes may be enlarged due to a variety of inflammatory, infectious, or malignant reasons. Therefore, obtaining samples from the affected nodes is crucial for the diagnosis. Usually, these patients are subjected to TBNA (EBUS or conventional) or mediastinoscopy if TBNA is not conclusive. This study evaluated the safety and feasibility of this new technique of transbronchial forceps biopsy for the diagnosis of mediastinal lymphadenopathy.

METHODS: The study included 18 patients with confirmed mediastinal lymphadenopathy who were admitted in Chest Department, Cairo University in the period from December 2019 to December 2020. All patients were subjected to flexible bronchoscopy with conventional transbronchial needle aspiration (C-TBNA) and transbronchial forceps biopsy (LN-TBFB) from the enlarged mediastinal lymph node in the same procedure.

RESULTS: we found the technique of LN-TBFB safe with no serious complications. We were able to reach a diagnosis in 7/7 (100%) cases of sarcoidosis, 6/7 (85.7%) cases of malignant lymph nodes. We had three cases where the histopathology showed hyperactive follicular hyperplasia, and a single case of tuberculous lymphadenitis. C-TBNA was diagnostic in 71.4% of sarcoidosis cases, 42.9% of malignant cases, but failed to diagnose the one patient with tuberculous lymphadenitis.

CONCLUSION: Lymph node transbronchial forceps biopsy (LN-TBFB) was found to be safe and effective in the diagnosis of mediastinal lymphadenopathy. We strongly advocate the use of this minimally invasive technique for diagnosing pathologically enlarged mediastinal lymph nodes, as a last step before mediastinoscopy.

Matched MeSH terms: Mediastinum/pathology

Fulltext Surgical Management of Bulky Mediastinal Metastases in Follicular Thyroid Carcinoma

Adwin Z, Nur A, Suhaimi S, Rahman R

Oman Med J, 2016 Jan;31(1):69-72.

PMID: 26816570 DOI: 10.5001/omj.2016.13

Follicular thyroid adenoma and carcinoma are very common. Benign and malignant lesions are usually indistinguishable from cytology alone and often require confirmatory resection. The spread of follicular carcinoma is usually hematogenous and is treated with surgery and adjuvant radioactive iodine. Very rarely, metastases occur in the mediastinum. Patients usually present with severe compressive symptoms. With proper treatment and follow-up, the prognosis for these type of thyroid malignancies is excellent. In the case presented here, our patient presented to the Universiti Kebangsaan Malaysia Medical Center with a progressively enlarging anterior neck swelling. The swelling had started 10 years before his presentation. We diagnosed him with an advanced thyroid malignancy with bulky mediastinal metastases. After extensive investigations and counseling, we chose to treat the patient with tumor excision and mediastinal metastases resection. Typically, mediastinal resection involves the removal of the sternum and use of an acrylic implant to recreate the sternum. In this case, the sternum and ribs were removed with subsequent myocutaneous flap coverage for the wound defect. Our experience represents an alternative treatment option in cases where implant use is unsuitable.

Matched MeSH terms: Mediastinum

Displaying publications 1 - 20 of 31 in total