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BACKGROUND The management of foregut duplication cysts is controversial, especially in asymptomatic patients. The safety and accuracy of endoscopic ultrasound (EUS) and EUS‐fine‐needle aspiration EUS‐FNA) in confirming the nature of cysts by using electron microscopy (EM) has not been reported. In this study, the authors describe the utility of demonstrating detached ciliary tufts (DCTs) in the diagnosis of foregut duplication cysts with EUS‐FNA. METHODS Consecutive patients with suspected mediastinal masses or mediastinal cysts on imaging studies were evaluated prospectively by EUS and EUS‐FNA. Cyst fluid was examined by routine cytologic techniques. In two patients, EM was performed to confirm the nature of DCTs. RESULTS Ten consecutive patients were evaluated with EUS and EUS‐FNA. Seventy percent of the cysts were characterized by computed tomography (CT) scans as solid masses. The mean greatest cyst dimension measured 34 mm × 48 mm by EUS. Microscopic examination of the cyst content revealed mucinous material, cellular debris, and DCTs. The latter were seen in routine cytologic preparations and by EM. Patients were followed up to a median of 321 days. Due to EUS‐FNA confirmatory diagnoses of foregut duplication cysts, none of the patients except 1 underwent surgical resection after developing pneumonia 6 months later. Histologic sections of the resected specimen confirmed the presence of (foregut cyst, bronchogenic type). All other patients were asymptomatic. Cysts size and nature did not change on repeated imaging studies. CONCLUSIONS EUS was superior compared with CT scanning in characterizing foregut duplication cysts. EUS‐FNA is safe and accurate in the diagnosis of foregut duplication cysts. The demonstration of DCTs in cyst fluid and the absence of malignant cells confirmed the benign nature of these lesions, allowing conservative and expectant management for these patients. Cancer (Cancer Cytopathol) 2004. © 2004 American Cancer Society.

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The treatment for pneumothorax varies from invasive chest tube drainage to conservative management with bed rest. Based on the behavior of gases in closed body cavities, the inhalation of supplemental oxygen hastens absorption of the pneumothorax. To evaluate oxygen as a therapeutic agent, we treated 8 patients with pneumothoraces of various degrees with a high concentration of inspired oxygen delivered by a partial rebreathing mask. Periodic roentgenograms were used to measure the change in size of pneumothorax in order to assess the rate of resolution. 6 patients with pneumothoraces of less than 30% showed a mean resolution rate of 4.2% per day with reduction to one-third original size in the first 72 h. This was more than three times the rate of resolution (1.25% per day) previously reported with breathing room air alone. In 2 patients who initially received a lower concentration of inspired oxygen via nasal cannula, the rate of absorption increased after placing them on a partial rebreathing mask. 2 patients with four episodes of pneumothoraces greater than 30% did not benefit from this form of therapy and eventually needed chest tube drainage. We conclude that the administration of high concentrations of inspired oxygen is an effective method to enhance the rate of resolution of pneumothoraces, particularly when smaller than 30%, thereby reducing morbidity and duration of hospitalization and avoiding invasive drainage procedures.