title: Management of cervical thoracic duct cyst with cyst-venous anastomosis.
abstract: BACKGROUND
  Cervical thoracic duct cyst (CTDC) is a rare cause of lateral neck mass. Surgical excision with ligation of the cervical thoracic duct is the current standard for definitive management with symptomatic patients. We report the first case of an alternative method of management performing a cyst venous anastomosis for decompression.
  
  
  METHODS
  A 77 year old female presented with a six month history of left arm pain, swelling and a left-sided cystic neck mass. She was treated with cyst-venous anastomosis between the cyst wall and the left internal jugular vein. At two year follow-up, she has had resolution of pain and no recurrence of the mass.
  
  
  CONCLUSIONS
  Many potential etiologies have been proposed for CTDC, though surgical management of this rare problem has consistently required cyst excision and thoracic duct ligation. Few innovative modes of therapy have been developed to address this problem in a less invasive manor. Maintaining a more natural thoracic duct anatomy decreases the likely of complications associated with duct ligation.
  
  
  CONCLUSIONS
  Cyst-venous anastomosis for the management of CTDC provides an effective, novel form of treatment which maintains the integrity of the thoracic duct and avoids potential complications associated with duct ligation.
authors.affiliation: Department of Surgery, Mayo Clinic, Jacksonville, FL, United States. Electronic address: Dortch.john@mayo.edu.
authors.forename: John D
authors.initials: JD
authors.lastname: Dortch
authors.affiliation: Department of Surgery, Mayo Clinic, Jacksonville, FL, United States.
authors.forename: Dustin
authors.initials: D
authors.lastname: Eck
authors.affiliation: Department of Surgery, Mayo Clinic, Jacksonville, FL, United States.
authors.forename: Albert G
authors.initials: AG
authors.lastname: Hakaim
authors.affiliation: Department of Otorhinolaryngology, Mayo Clinic, Jacksonville, FL, United States.
authors.forename: John D
authors.initials: JD
authors.lastname: Casler
keywords: Cervical thoracic duct cyst; Cyst-vein anastomosis; Lymphovenous anastomosis