Parenchymal cysts

Parenchymal cysts DEFAULT

Pulmonary cysts identified on chest CT: Are they part of aging change or of clinical significance?

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Parenchymal perianeurysmal cyst in the brain: case report

Objective and importance: Parenchymal perianeurysmal cysts are rare, and only seven cases have been reported. We present a case report with a 30 month follow-up on this topic. The possible etiopathogenetic mechanisms of cyst formation are discussed.

Clinical presentation: A 54-year-old man with a 5-month history of headache and a computed tomography scan showing a giant parenchymal cyst located in the right temporal lobe with a mural enhanced nodule was admitted to our neurosurgical department with the diagnosis of cystic brain tumor. Magnetic resonance imaging followed by digital subtraction angiography identified the enhancing nodule as a large right middle cerebral artery aneurysm.

Intervention: Surgical treatment was performed; the aneurysm was clipped and the cyst evacuated. Postoperative digital subtraction angiography confirmed the clipping of the aneurysm at the neck. Serial magnetic resonance imaging controls showed the permanent collapse of the cyst.

Conclusion: Parenchymal perianeurysmal cysts are rare. In the presence of parenchymal cysts neighboring main vessels, the possibility of a perianeurysmal cyst should be considered. In regard to the etiopathogenetic mechanisms responsible for the cyst development, the action of multiple coexisting factors seems to be the most applicable.

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Pulmonary cysts are round, thin-walled, low attenuation spaces/lucencies in the lung. Lung cysts usually contain air but occasionally also contain fluid or solid material 5.

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In contradistinction to all other organs, the term cyst as used in the lung is a misnomer, as it usually refers to a contained focus of gas, not fluid.

Pulmonary cysts can be congenital or acquired. Multiple lung cysts in a child may be associated with an underlying process although this is rare, e.g. pleuropulmonary blastomas1.

There are several specific types of thin-walled cystic spaces in the lungs 6,7:

  • bleb: pleural/subpleural, ≤1-2 cm diameter
  • bulla: pleural/subpleural, ≥1-2 cm diameter
  • honeycombing: subpleural stacks of cysts, typically 3-10 mm diameter with walls 1-3 mm in thickness
  • pneumatocele: usually transient cystic airspace within the lung, usually due to pneumonia or trauma

There are several mimics of pulmonary cysts:

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  • 5. Cantin L, Bankier AA, Eisenberg RL. Multiple cystlike lung lesions in the adult. AJR Am J Roentgenol. 2010;194 (1): W1-W11. doi:10.2214/AJR.09.3540 - Pubmed citation
  • 6. Hansell DM, Bankier AA, MacMahon H, McLoud TC, Müller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. (2008) Radiology. 246 (3): 697-722. doi:10.1148/radiol.2462070712 - Pubmed
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Ultrasound Video showing a large Ovarian Cyst with renal parenchymal disease

Symptomatic perianeurysmal parenchymal cyst: case illustration

A 74-year-old woman presented with chronic headache and gait imbalance. Examination revealed left pronator drift and dysmetria. Contrasted MRI revealed a right frontotemporal enhancing lesion (Fig. 1A) with adjacent nonenhancing cyst (Fig. 1B). Differential diagnosis included primarily vascular or neoplastic entities; the patient declined intervention, so serial imaging was recommended. At 9 months (Fig. 1C) the cyst had enlarged. At 12 months she developed progressive left hemiparesis and was nonambulatory. Noncontrasted CT revealed further cystic enlargement; she declined further studies including vascular imaging.

Intraoperative findings included a glial cyst filled with greenish fluid and a firm, smoothwalled mass with a traversing artery (Fig. 1D). Intraoperative micro-Doppler identified arterial pulsation in the lesion; intraoperative angiography confirmed the diagnosis of distal middle cerebral artery (MCA) aneurysm. Videoangiography confirmed retrograde filling of the distal vessel and aneurysm occlusion via trapping. Postoperatively there was immediate improvement in left-sided symptoms, with return of ambulation at follow-up.

FIG. 1.

Initial axial T1-weighted postcontrast (A) and T2 FLAIR (B) MR images revealing an enhancing nodule with surrounding ring enhancement (arrow) and adjacent nonenhancing cyst (asterisk) in the posterior right temporal lobe. The cyst demonstrates growth on T2 FLAIR imaging at 9-month follow-up (C). Of note, the cyst fluid differs from CSF on the FLAIR sequence. Intraoperative photograph (D) demonstrating the large smooth-walled structure (asterisk), with a distal MCA branch entering and leaving (arrows). Micro-Doppler probe (p) confirmed arterial pulsation in the suspected aneurysm. Figure is available in color online only.

Perianeurysmal parenchymal cysts are rare, with few reported cases.1 Cyst formation may involve ischemic encephalomalacia, hemorrhage, or inflammation related to aneurysm thrombosis.4 Cyst resolution postembolization is described,3 but when symptomatic, surgical drainage remains effective. Prior descriptions report an enhancing nodule with surrounding cyst,1,2 which may be mistaken for a neoplasm.1 This is the first description of an enlarging perianeurysmal cyst without aneurysm change or hemorrhage. In the absence of preoperative vascular imaging, we demonstrate the value of intraoperative micro-Doppler as a safe and timely technique to evaluate an encapsulated lesion of concern as a possible aneurysm.


  • 1↑

    BenvenutiL, , GagliardiR, , ScazzeriF, & GaglianoneS: Parenchymal perianeurysmal cyst in the brain: case report. Neurosurgery58:E788, 2006

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  • 2↑

    HirotaN, , UenoJ, , NaitohH, , SugiyamaK, , KarasawaH, & KinH, et al.: Giant aneurysm associated with a large cyst. Case illustration. J Neurosurg91:160, 1999

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  • 3↑

    Martinez GaldamezM, , Saura LorenteP, , Palomera RicoA, & Pérez-HiguerasA: Intracranial peri-aneurysmal cyst: still a dilemma. A case report with endovascular management. Neuroradiol J24:743–748, 2011

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  • 4↑

    SatoN, , SzeG, , AwadIA, , PutmanCM, , ShibazakiT, & EndoK: Parenchymal perianeurysmal cystic changes in the brain: report of five cases. Radiology215:229–233, 2000

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Cysts parenchymal

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