Foregut cyst of the mediastinum: fluid re-accumulation after transbronchial needle aspiration.

Abstract

Cysts arising from embryonic remnants of the primitive foregut include bronchogenic cyst, oesophageal duplication and neurenteric cyst (Kirwan et al, 1973). The place of computed tomography (CT) and needle biopsy in the diagnosis and the management of foregut cysts of the mediastinum has been demonstrated (Schwartz et al, 1985, 1986; Kuhlman et al, 1988). We report a case of a foregut cyst diagnosed and treated by these methods, but without long-term symptomatic relief inasmuch as symptoms recurred 3 years later with re-accumulation of fluid. In 1986, a 27-year-old man complained of vague right thoracic pain. A right mediastinal mass was discovered on chest radiographs (Fig. la, b). A CT scan showed a tubular cystic mass (internal density + 30 HU). This had regular and smooth borders and was located on the right side of the entire thoracic oesophagus (Fig. lc, d). There was no subdiaphragmatic extension and a CT scan of the upper abdomen did not show any abnormality. In particular, no pancreatic lesion was detected. A rigid bronchoscopy was performed and a Storz transbronchial needle was used to puncture the cyst transcarinally. This aspiration biopsy needle has an outer diameter of 1·4 mm. Seventy millilitres of clear, yellow fluid were aspirated and the procedure was well tolerated. Cultures of the fluid were negative and cytological examination showed no malignant cells. The presumptive diagnosis, based on CT and needle aspiration, was oesophageal duplication cyst.