No abstract

Both drugs selectively dilated the pulmonary vasculature in ventilated alveoli. Prostacyclin nebulization is an excellent tool to reduce pulmonary hypertension and to improve the ventilation/perfusion ratio. Prostacyclin nebulization can be used without the highly sophisticated technical equipment that is needed for controlled nitric oxide inhalation, and may therefore become a new, noninvasive therapeutic approach for treatment of adult respiratory distress syndrome in hospitals that cannot provide nitric oxide inhalation.

T horacic duct cysts are uncommon entities that most commonly occur in the abdominal and thoracic segments of the thoracic duct; the rarest reported location is the cervical segment. The first case of a cervical thoracic duct cyst was reported in 1964, 1 and a review of the literature that was published in 1999 identified only 10 such cases. 2 We describe a patient with a thoracic duct cyst, review the relevant literature, and discuss the characteristics, treatment, and diagnosis of these lesions. REPORT OF A CASEA previously healthy 41-year-old man presented with a 2-year history of a progressively enlarging left supraclavicular mass. There were no symptoms associated with the mass. The patient's medical history was noncontributory except for the excessive use of tobacco and alcohol. Examination of his neck revealed a partially mobile, globular, nontender mass in the left supraclavicular fossa that measured approximately 5 cm in diameter. The mass was nonpulsatile and compressible. The findings of the rest of the head and neck examination were unremarkable. A computed tomographic scan of the neck and chest with contrast revealed a nonenhancing, fluid-filled 4ϫ3 cm mass in the left supraclavicular fossa that was partially compressing the left internal jugular vein (Figure 1). There was no evidence of adenopathy. The mass, which was exposed through a neck crease incision placed in the lower part of the left side of the neck, appeared to be cystic in consistency and was located above the clavicle immediately proximal to the junction of the thoracic duct and the internal jugular and subclavian veins. The cyst was connected to the internal jugular vein by 2 small tubular pedicles, which were carefully divided between liga-tures before excision of the mass. The partially aspirated contents, which appeared milky, were sent for analysis. The neck incision was closed over a suction drain that was removed the next day, and the patient was discharged from the hospital. There were no postoperative complications. Analysis of the fluid that was aspirated intraoperatively revealed a triglyceride level of 817 mg/dL (9.22 mmol/L). Pathologic examination showed an ovoid unilocular cyst whose wall was composed of fibrous tissue and smooth muscle, with adipose tissue and lymphoid aggregates on its outer surface. The luminal surface had focal areas covered by a single layer of flat cells (Figure 2), which stained positively with immunohistochemical markers for CD31, CD34, factor VIII, and keratin. No staining was present with epithelial membrane antigen or calretinin. This pattern of immunoreactivity is consistent with endothelial or lymphatic cells. The histologic sections, pattern of immunoreactivity, and high triglyceride level support the diagnosis of a thoracic duct cyst. COMMENTThe thoracic duct enters the left side of the neck posterior to the inominate artery and arches 3 to 4 cm above the clavicle. It lies anterior to the vertebral vessels, sympathetic trunk, and thyrocervical trunk and empties into the left internal jugula...

Liposarcomas of the larynx are very rare. A review of the English literature revealed only 28 published reports of tumours in this anatomical location. Diagnosis requires a high index of suspicion and careful histologic analysis. We present a case of a well-differentiated liposarcoma of the epiglottis, the tenth reported case at this laryngeal subsite. Initial biopsy specimens showed histological characteristics of a liposarcoma, which facilitated provision of optimal surgical treatment after careful analysis of published literature.