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A 27-year-old male patient presented to the thoracic surgery clinic with intermittant
fluctuating mass and pain at the right side of the neck. Physical examination revealed
a mobile mass at the right supra-clavicular region and Horner's syndrome. Chest X-ray
showed an unusual opacity at the apex of the right lung (Supplementary data, Fig. S1). Ultrasonography indicated erosion of the first rib and a cystic lesion including
multiple septations (Supplementary data, Fig. S2). Pathology was further investigated with computed tomography (CT) revealing 13 cm × 8 cm × 7 cm lobulated cystic lesion (Supplementary data, Fig. S3) and magnetic resonance imaging (MRI) indicating a lobulated mass localised to the
chest wall at the thoracic inlet protruding from the chest to the neck (Supplementary data, Fig. S4; Fig. 1). Surgical treatment was organised with cautions according to the most probable preoperative
diagnosis of hydatid cyst disease. Removal of the lesion through neck incision or
thoracotomy was discussed and the decision was through thoracic approach. Additional
diagnostic measures such as biopsy or serological tests were not fashioned. Through
right thoracotomy, the cyst was sterilised and evacuated (Supplementary data, Fig. S5; Fig. 2). The wall of the cyst was partially excised (Supplementary data, Fig. S6), and the cavity was then plicated and closed.
Figure 1Magnetic resonance imaging indicating a lobulated mass localised to the chest wall
at the thoracic inlet protruding from the chest to the neck.
