Cyst

Fluid-fluid level in cystic vestibular schwannoma: a predictor of peritumoral adhesion.

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Abstract

OBJECT

The aim of this study was to evaluate the clinical results and surgical outcomes of cystic vestibular schwannomas (VSs) with fluid-fluid levels.

METHODS

Forty-five patients with cystic VSs and 86 with solid VSs were enrolled in the study. The patients in the cystic VSs were further divided into those with and without fluid-fluid levels. The clinical and neuroimaging features, intraoperative findings, and surgical outcomes of the 3 groups were retrospectively compared.

RESULTS

Peritumoral adhesion was significantly greater in the fluid-level group (70.8%) than in the nonfluid-level group (28.6%) and the solid group (25.6%; p < 0.0001). Complete removal of the VS occurred significantly less in the fluid-level group (45.8%, 11/24) than in the nonfluid-level group (76.2%, 16/21) and the solid group (75.6%, 65/86; p = 0.015). Postoperative facial nerve function in the fluid-level group was less favorable than in the other 2 groups; good/satisfactory facial nerve function 1 year after surgery was noted in 50.0% cases in the fluid-level group compared with 83.3% cases in the nonfluid-level group (p = 0.038).

CONCLUSIONS

Cystic VSs with fluid-fluid levels more frequently adhered to surrounding neurovascular structures and had a less favorable surgical outcome. A possible mechanism of peritumoral adhesion is intratumoral hemorrhage and consequent inflammatory reactions that lead to destruction of the tumor-nerve barrier. These findings may be useful in predicting surgical outcome and planning surgical strategy preoperatively.

Source: http://thejns.org

Striking cysts: recurrent haematuria in a kickboxer.

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A 42-year-old man presented with recurrence of haematuria after extensive body-building exercises.

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He had a history of renal failure due to polycystic kidney disease, complicated by recurrent bleeding, particularly after kickboxing or body-building exercises. Ultrasonography  and abdominal CT scan without contrast  showed widespread polycystic kidney and liver disease. However, the source of bleeding could not be identified. MRI (T2-weighted, half-Fourier acquired single-shot turbo spin echo) showed multiple cysts with decreased signal density , suggestive of recent bleeding; this was further confirmed by distinct fluid levels in some of the cysts. Cyst bleeding is a common complication of polycystic kidney disease, occurring in 30—50% of cases. Our case shows that trauma can be a causative factor. MRI can elegantly reveal the exact location of cysts in which recent bleeding has occurred.

Source: Lancet

Hydatid pericardial tamponade: a grape soup.

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A 35-year-old Libyan woman was referred to us from another institution with the diagnosis of massive pericardial effusion and pericardial tamponade.

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On admission to us, she was hypotensive, tachycardic and tachypnoeic. Electrocardiography showed unspecific low QRS voltage and ST-T segment flattening. Chest x-ray showed cardiomegaly. We did an emergency pericardial aspiration which yielded 1500 ml of yellow coloured fluid. A transthoracic echocardiogrm showed multiple cystic formations approximately 1·5—2 cm within the pericardial cavity), and confirmed the need for surgery. We did a standard median sternotomy and thoroughly irrigated the pericardium with hypertonic saline; multiple cysts were removed from the pericardium (figures B and C). Our patient was diagnosed with a ruptured intrapericardial hydatid cyst and pericardial tamponade. We established the diagnosis based on the gross appearance of the removed cysts, the echocardiogram results, and a high ESR. Hydatid disease is endemic in Libya, a southern Mediterranean country. Serological tests were not available. After surgery she was treated with oral albendazole for 12 days. She recovered well and was discharged 12 days after surgery. Pericardial tamponade due to hydatid disease is a rare condition that has been seldom reported in the literature.

Source: Lancet