Direct puncture sclerotherapy of a thoracic duct cyst presenting as an enlarging left supraclavicular mass

Abstract

SUMMARYA 58-year-old woman presented with a palpable mass at the base of the left neck which she had first noticed 12 years previously, shortly after abdominal surgery. The mass had progressively enlarged, resulting in dysphagia, dyspnea and occasional pain. Imaging showed a septated but otherwise simple cystic mass extending into the mediastinum and containing lymphocytic fluid on aspiration. A diagnosis of the rare entity of a thoracic duct cyst with supraclavicular extension was made. The patient opted for percutaneous sclerotherapy of the lesion, which was performed using glacial acetic acid. This resulted in complete resolution of the mass with one treatment. After exclusion of other causes of cystic left supraclavicular masses including cystic neoplasms and pseudoaneurysms of the carotid or subclavian arteries, direct puncture sclerotherapy can be safe and effective. BACKGROUND

Recurrent thoracic duct cyst of the left supraclavicular fossa

“…Lymphoscintigraphy is the benchmark because it provides a proper analysis of the shape of the thoracic duct and can measure its drainage rate. [ 9 , 14 , 19 , 21 ] Today, CT-scans and MRIs are more commonly used.…”

“…In the case of the “Nutella Syndrome,” imaging taken after the acute crisis must be normal. Lymphoscintigraphy is the benchmark because it provides a proper analysis of the shape of the thoracic duct and can measure its drainage rate [9,14,19,21] . Today, CT-scans and MRIs are more commonly used.…”

“…Moreover, this disease has probably been underestimated and underdiagnosed since only 6 observed cases at 3 internal medicine departments were found over a 10-year period in the medical facilities. It should, however, remain a diagnosis of exclusion and it may be therefore crucial to exclude differential diagnoses such as a tumor-like metastatic lesions, a parathyroid or thymic cyst, [6][7][8][17][18][19] sequelae of a prior injury (whether surgical or other including birthing, whiplash and stretching), [8,15,18] lymphangioma [6,17,19] or hematoma. [11] In these cases, a clinical examination and medical imaging during the acute phase should guide a clinician.…”

“…Lymphoscintigraphy is the benchmark because it provides a proper analysis of the shape of the thoracic duct and can measure its drainage rate. [9,14,19,21] Today, CT-scans and MRIs are more commonly used. Lymphoscintigraphy is time-consuming, invasive, and can be difficult to interpret in the absence of standardized procedures [2,21] since normal diffusion time values are from 10 to 30 minutes and considered delayed after 120 minutes.…”

Multiple thoracic duct cysts: an unusual CT finding

“…The use of video-assisted thorascopic surgery could be further explored for patients who require excision of mediastinal cysts. Sclerotherapy has been successfully used for a large supraclavicular cyst [ 5 ], in addition to traditional surgical excision.…”