Abstract
A 66 year old woman presented in extremis with symptoms and clinical and radiological signs of simultaneous obstruction of superior vena cava and middle lobe of right lung secondary to compression by a massive benign anterior mediastinal cyst. Excision of the cyst at median sternotomy resulted in complete resolution of all symptoms. This report is unusual on account of a) the concomitant presence of superior vena cava and middle lobe syndromes caused by a benign cyst because of its sheer size producing obstruction of these structures and b) the complete resolution of all symptoms and signs after removal of the cyst. Benign anterior mediastinal cysts are unknown to cause either of the two syndromes. To our knowledge, it is the first report of a benign anterior mediastinal cyst causing either superior vena cava syndrome or middle lobe syndrome or both simultaneously. Etiologies of both superior vena cava and middle lobe syndromes are discussed in detail.
Highlights
A 66 year old hypertensive and asthmatic chronic smoker presented with 8 month history of progressively increasing shortness of breath
The cysts may originate from pleura or pericardium, tracheobronchial tree, gastrointestinal tract, neurogenic tissue, thymus gland or
IwFniitgtrhuaorhepae9rmaotirvrehpahgioctfolugirdaph showing the thin walled cyst filled Intraoperative photograph showing the thin walled cyst filled with haemorrhagic fluid
Summary
Primary mediastinal cysts constitute approximately one fifth of all mediastinal masses. Bronchogenic cysts, which almost always arise in the visceral compartment, in close relation to the trachea or bronchi, get infected more frequently, when there is a persistent communication with the tracheobronchial tree It is extremely unusual for benign anterior mediastinal cysts to cause compressive mediastinal symptoms, because most normal, mobile mediastinal structures can conform to pressure. Middle lobe syndrome can be caused by entities as diverse as carcinoma of middle lobe bronchus, mucosa associated lymphoid tissue (MALT) lymphomas [8] or sclerosing Hodgkin's disease, primary benign endobronchial diseases like tuberculosis [9] and sarcoidosis, strictures of unknown etiology, foreign bodies[10], fibrosing or resolving pneumonitis, sclerosing mediastinitis, histoplasmosis, aspergillus [11] or blastomyces [12] infections, obliterative bronchitis [13], bronchiectasis, bronchial hyper-responsiveness (BHR) and asthma [14] and, rarely, bronchogenic or esophageal duplication cysts. A copy of the written consent is available for review by Editor-in-Chief of this journal
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