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European Journal of Cardio-Thoracic Surgery 44 (2013) 1153 IMAGES IN CARDIO-THORACIC SURGERY doi:10.1093/ejcts/ezt231 Advance Access publication 26 April 2013 a,† a,†, b a Luigi Ventura , Luca Ampollini *, Letizia Gnetti and Michele Rusca Department of Thoracic Surgery, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy Pathology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy * Corresponding author. Chirurgia Toracica, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43126 Parma, Italy. Tel: +39-0521-702290; fax: +39-0521-703559; e-mail: lampollini@ao.pr.it (L. Ampollini) Received 5 February 2013; revised 21 March 2013; accepted 28 March 2013 Keywords: Hydatid disease � Magnetic resonance imaging � Hydatid cyst � Supraclavicular fossa A 29-year old woman presented with an asymptomatic left supra- A surgical removal was proposed: the cyst was enucleated from clavicular cyst (Fig. 1). Thirteen years earlier, the patient underwent the surrounding tissue (Fig. 2). The patient had an uneventful re- surgical drainage of the left supraclavicular hydatid cyst elsewhere. covery. No recurrence was observed after 58 months. Figure 1: A nuclear magnetic resonance revealed a 4 × 3-cm-sized multiloculated cyst. The lesion lay anteromedially to the trapezius muscle; inferiorly, it wasin contact with the distal part of the left clavicle and scalene muscles that appeared lightly medially dislocated. The left external jugular vein was placed medially to the cyst, while the left subclavian artery and vein were caudally located at a distance of 10 mm. The cyst was hyperintense on T -weighted black-blood images not suppressed in fat suppression sequences (transversal A and frontal B view, respectively). Thus, a recurrent hydatid disease was hypothesized. No albendazole therapy was administered after the previous operation. Figure 2: The cyst was approached through a 4-cm incision in the left supraclavicular fossa. Macroscopically, a roundish lesion of 35 × 32 mm, organized in a poly- cystic structure, was seen. The cyst was dissected free from surrounding tissue safely. Histopathological findings of haematoxylin and eosin sections revealed double-layered, outer laminated hyaline (4×, A, asterisk) and inner granular germinal membranes (4×, A, double asterisks). The proligerous membrane (B, caret), cuticular membrane (B, open circle) and pericyst (B, asterisk) were clearly evident at major enlargement (10×). Tracks left by the scolices were also visible (B, arrowheads). The first two authors contributed equally to this work. © The Author 2013. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. IMAGES IN CARDIO- THORACIC SURGERY
European Journal of Cardio-Thoracic Surgery – Oxford University Press
Published: Dec 26, 2013
Keywords: Hydatid disease Magnetic resonance imaging Hydatid cyst Supraclavicular fossa
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