Ali Asad1, Maira Nusrat1, Umair Hamid1, Muhammad Hasib Khalil1, Quratulain Fatima Masood2*, Hasan Raza Hashmi3, Irbaz Ahmed3, Sara Habib, Arham Hiran , Fiaz Hussain5, Saad Javaid5, Maira Shahid6, Faryal Ali6, Fnu Sandeep6, Atif Ibrahim7, Hamza Bajwa8, Amna Ejaz8, Moeed Ahmed8, Hafiz Zarsham Ali Ikram8, Amar Lal9and Wardah Siddiq10
1University of Health Sciences Lahore, Pakistan
2National University of Science and Technology, Pakistan
3Agha Khan University Karachi, Pakista
4Ziauddin University, Pakistan
5Nishtar Medical University Multan, Pakistan
6Dow University of Health Sciences, Pakistan7Ayub Medical College, Khyber University Peshawar, Pakistan
8King Edward Medical University Lahore, Pakistan
9Research Assistant, University of Arizona, USA
10Army Medical College Pakistan, Pakistan
Submission: April 30, 2018; Published: May 09, 2018
*Corresponding author: Quratulain Masood, National University of Sciences and Technology, Karachi, Pakistan, Email: firstname.lastname@example.org
How to cite this article: Ali Asad, Maira Nusrat, Umair Hamid, Muhammad Hasib Khalil, Quratulain Fatima Masood.et.al. A Case of Mesothelial Cystic Mediastinal Mass. J Anest & Inten Care Med. 2018; 6(4): 555695. DOI: 10.19080/JAICM.2018.06.555695
A 65 year old woman presented with vague chest pain and shortness of breath. General physical and systemic examinations were unremarkable. Chest X-Ray showed a large mass in the anterio-superior mediastinum. Computed Tomography (CT) Scan showed a well-defined soft tissue mass with broad base towards the pleura in the right upper lung zone measuring 7.9X7.5X7 in transverse, crainio-caudal and AP dimensions, respectively. CT- guided Fine needle aspiration biopsy was done which was nondiagnostic. Bacterial cultures and AFT cultures turned out to be negative. Median sternotomy was done, and the entire mass was excised. The excised mass was sent for histopathology. The FNA was not diagnostic. The histopathology proved it to be primary mesothelial cyst of the mediastinum. The patient made uneventful recovery postoperatively.
Primary cysts of mediastinum include bronchogenic cysts, enteric or duplication cysts, mesothelial cysts, thymic cysts, an thoracic duct cysts . Mesothelial cysts are fluid filled sacs lined by Mesothelial cells . They are usually unilocular and can be found in various sites like liver , round ligament , pericardium , peritoneal cavity , spermatic cord , adrenal gland  kidney  and spleen . Intrathoracic mesothelial cysts are congenital lesions due to an anomaly in the development of the pericardial coelom . They are classically located in the anterior cardiophrenic angle but rarely can they be found elsewhere in the paravertebral region, the anterior mediastinum  or the paratracheal regions . Mesothelial cysts include a variety that has been reported as pleuropericardial, pleural and simple mesothelial cysts.
Pathologically, the cyst wall consists of a single layer of flattened endothelial cells with an underlying connective tissue stroma. They are often detected as an abnormal shadow on routine chest x-ray films, occurring at an incidence of 1 in 100,000 . As reported by two old case series, they are located in the right cardio-phrenic angle in 51%-71% of cases, and in the left cardiophrenic angle in 22%-38% of cases [15,16]. Surgical resection is the ideal treatment of these lesions, and is classically performed by thoracotomy [17,18]. Mesothelial cystic mediastinal mass is considered as a rare mesothelioma.