Clinical Spectrum of Mediastinal Cysts: Surgery and Outcome
The two patients with meningoceles appeared without respiratory symptoms. Recurrent chest pain was associated with the thoracic duct cyst similar to the previous report.
As for the diagnostic modality, chest radiograph was once the most cost- and time-efficient method of diagnosing surgical lesions, and was the only diagnostic tool in our early series. Before the introduction of CT scan, pneumomediastinum used to be a diagnostic tool for mediastinal mass. Currently, mediastinal cysts can be accurately diagnosed with imaging modalities such as CT, MRI, and ultrasonography. The appropriate diagnostic test allows for efficient treatment, avoiding complications. The plain chest radiograph serves as the starting point for diagnostic evaluation, and MRI is an ultimately useful tool for providing supplemental data in combination with CT. In addition, asymptomatic cystic lesions were sometimes found during examination or follow-up for other diseases.
Short-term results after extirpation of mediastinal cysts are excellent, and operative morbidity is acceptable as well as eliminating symptoms. We concluded that the diagnosis of a symptomatic mediastinal cyst is an indication for complete extirpation in all patients. In this sense, surgical excision is definitely diagnostic and therapeutic; therefore, watchful waiting is discouraged. The options for treatment of foregut cysts or thymic cysts including mediastino-scopic aspiration in symptomatic patients have been reported, but these methods should be exceptionally preferred as temporary procedures in selected cases. There were some concerns about the indications of surgery for asymptomatic patients with mediastinal cysts after establishing the diagnosis due to their benign nature.