Thoracic, Thoraco-abdominal, and Abdominal Duplication.

Christine G. aged 8 years was admitted to this unit for elective thoracotomy for a bi-lobed right-sided posterior mediastinal lesion. At the age of 7 months she had been admitted to another hospital with profuse melaena. On 1 May 1956 laparotomy revealed a small bowel duplication 50 cm. in length, terminating distally in what appeared to be a Meckel's diverticulum. At the base of the diverticulum an ulcer was found. Conservative resection was undertaken owing to the poor condition of the infant. Further melaena necessitated a second laparotomy on 16 May, and the remaining part of the duplication and adjacent small bowel was resected (Fig. 1). Histology revealed the mucosa around the ulcer to be intestinal in type but that of the remaining duplication resembled gastric mucosa with oxyntic cells. Post-operative respiratory difficulties necessitated the taking of a chest radiograph which showed a bi-lobed lesion in the right hemithorax. At laparotomy it had been noted that the right kidney appeared enlarged, and a subsequent intravenous pyelogram demonstrated wide separation of the calyces of the right kidney suggestive of polycystic disease. The left kidney was normal (Fig. 2). The child had no chest symptoms but it was decided to explore and, if possible, remove the intrathoracic mass. On admission to this unit in 1963 examination of the child's chest revealed dullness to percussion over the base of the right lung posteriorly with diminished air entry in this area. Otherwise the respiratory system was clinically normal. On examination of the cardiovascular system the apex beat of the heart was found to be 0-5 in. (12-7 mm.) lateral to the left midclavicular line in the fifth intercostal space. The cardiovascular system was otherwise normal. In the abdomen a rounded, smooth, soft mass was palpable in the right hypochondrium. The mass was dull to percussion, and the liver could not be identified separately from the mass. There was no clinically detectable spinal deformity. A radiograph of the chest revealed two smoothly rounded opacities lying posteriorly in the right hemithorax. The lower opacity showed a small plaque of calcification (Fig. 3). Radiographs of the spine revealed no gross abnormality but some scalloping of the anterior surface of the second dorsal vertebra some loss of disc space between the fifth and sixth dorsal vertebrae could be demonstrated on the lateral projection films. On 29 October 1963 a right thoracotomy was made in the face-down position through the bed of the sixth rib. A lobulated cystic structure was present in the posterior meditastinum which extended down to the right diaphragm. Aspiration proved that these were two cysts. The upper cyst was found to be firmly adherent to the sixth dorsal vertebra. No oesophageal or tracheal attachment of either cyst could be demonstrated. The inferior cvst was opened. and probing