ro13-9904 and Mediastinal-Cyst

A previously healthy 3-year-old boy presented to the emergency department with abdominal pain, fever, and emesis. Laboratory and radiologic evaluation for causes of acute abdomen were negative; however, review of the abdominal x-ray demonstrated cardiomegaly with the subsequent diagnosis of pericardial cyst by echocardiogram and computed tomography. The patient underwent surgical decompression and attempted removal of the cystic structure revealing that the cyst originated from the epicardium. His abdominal pain and fever resolved postoperatively and he completed a 3-week course of ceftriaxone for treatment of Propionibacterium acnes infected congenital epicardial cyst. Emergency department physicians must maintain a broad differential in patients with symptoms of acute abdomen to prevent complications from serious cardiac or pulmonary diseases that present with symptoms of referred abdominal pain.

Topics: Abdomen, Acute; Anti-Bacterial Agents; Ceftriaxone; Child, Preschool; Decompression, Surgical; Diagnosis, Differential; Echocardiography; Emergency Service, Hospital; Gram-Positive Bacterial Infections; Humans; Male; Mediastinal Cyst; Propionibacterium acnes; Radiography, Abdominal; Tomography, X-Ray Computed; Treatment Outcome

A 28-year-old male was diagnosed with acute pericarditis after presenting with acute chest pain, fever and an abnormality in an electrocardiogram. No symptoms suggestive of myasthenia gravis were observed. Although the symptoms were alleviated by antibiotics, computed tomography (CT) showed an anterior mediastinal mass with bilateral pleural effusion. He was, therefore, diagnosed with thymoma and referred to our hospital. Surgery was performed, since the pleural effusion disappeared. The pathological examination revealed the mass to be a type B2 thymoma classified as pathological stage I (Masaoka's classification) with a multilocular thymic cyst.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Ceftriaxone; Humans; Magnetic Resonance Imaging; Male; Mediastinal Cyst; Mediastinal Neoplasms; Pericarditis; Pleural Effusion; Thymectomy; Thymoma; Tomography, X-Ray Computed; Treatment Outcome