Clinical Spectrum of Mediastinal Cysts: Mediastinum
St-Georges et al reviewed 86 bronchogenic cysts and found major complications such as fistulization with airway, and ulcerations or hemorrhage in mediastinal cysts that were observed with parenchymal cysts. In addition, other potential complications including arrhythmia or superior vena cava syndrome may occur. Another important issue is that malignancy is associated with bronchogenic cysts.
As for esophageal cysts, by reviewing previous reports, approximately one half of the patients with esophageal cysts were asymptomatic and discovered incidentally. Three of four patients with this disease were asymptomatic at presentation in our experience. We encountered one patient with an esophageal duplication cyst who visited us complaining of fever and chest pain due to acute enlargement and rupturing into the mediastinum.
Thymic cysts were regarded to be usually asymptomatic, located in the anterior mediastinum, and were incidentally discovered on a chest radiograph. Graeber et al reported that only 6 of 46 patients (13%) had symptoms. Unusual presentations such as respiratory distress and Horner syndrome have been reported. In our series, thymic cysts represented 28.6% of mediastinal cysts and 3.7% of total mediastinal tumors. As shown in Table 3, 40% of patients were symptomatic, a similar prevalence to those with bronchogenic cysts in the current study. Such cases presented with relatively large masses of 7 to 13 cm in size. Notably, hoarseness was the second most common symptom in our series. However, patients with cystic masses in the thymus have been reported to be asymptomatic.
In our experience, patients with pericardial/pleural cysts had lower incidences of symptoms than other mediastinal cysts; however, one patient with an expanding pleural cyst who presented with cyanosis and respiratory distress needed an emergency operation.