Solitary cystic mediastinal lymphangioma

Abstract

To the Editor: Solitary cystic mediastinal lymphangioma (CML) is a very uncommon benign vascular tumour developed from lymphatic vessels. Cystic lymphangioma is a cyst caused by a congenital malformation of the lymphatic vessels and can affect any site in the body, but <1% of lymphangiomas are mediastinal [1] and pulmonary lesions are even less common. They are most often located in the anterior mediastinum. We report a case of anterior CML in a 16-yr-old male, with a short review of the literature. A 16-yr-old male was admitted to the Thoracic Oncology unit (Hopital Nord, Marseilles, France) for recurrent left pleural effusion. The patient reported a 6-month history of chest pain and dyspnoea with hyperthermia. An initial diagnosis of left empyema was suspected. It was managed by iterative thoracentesis with saline pleural lavages, antibiotics and physiotherapy. On admission, physical examination was unremarkable except for left-sided dullness on percussion. The patient was afebrile. Chest radiography revealed a large basal opacity of the left lung silhouetting out the heart and diaphragm. Initially, this opacity was thought to represent a recurrent pleural effusion (fig. 1a). Computed tomography scans revealed a cystic lesion in the left basithoracic and anterolateral pleura with smooth borders measuring 63×90 mm (fig. 1b). No other intra- or extrapulmonary cystic lesions were found. With a presumptive diagnosis of a pleuropericardial cyst, video-assisted thoracic surgery was performed. Cytology and bacteriology were performed. The cyst contained serous fluid and had no connection or adhesion to adjacent organs, and was vascularised by …