Mediastinal cystic masses are well-marginated, round, epithelium-lined lesions that contain fluid. They include a variety of entities with overlapping radiologic manifestations and variable prognoses. Cysts comprise 15%–20% of all mediastinal masses (,1) and occur in all compartments of the mediastinum.
2. MEDIASTINAL CYST
• Mediastinal cystic masses are well-marginated,round,epithelium-
lined lesions that contain fluid.
• Cyst comprise 15%-20% of all mediastinal masses and occur in all
compartments of the mediastinum.
• It occurs at any age group,in both sexes.
• It is often identified on a round chest X-ray,as about 50% are
symptomless.
3. CAUSES
• Most of the mediastinal cysts are congenital with bronchogenic cysts
being the most common.
• Cystic degeneration of mediastinal lymph nodes due to malignancy or
infection.
4. CLASSIFICATION
MEDIASTINAL CYST IS CLASSIFIED ON THE BASIS OF LOCATION OR ETIOLOGY:
1.CONGENITAL CYST: MESOTHELIAL CYST
FOREGUT CYST
LYMPHATIC CYST
2.ACQUIRED CYST: INFLAMMATORY CYST
THYMIC TERATIGENOUS CYST
DERMOID CYST
PARATHYROID CYST
THYROID CYST
5.
6.
7. CLINICAL FEATURES
Symptoms are mostly seen in pediatric population and less often seen in adults.
Clinical features include:
❑Chest pain and back pain
❑Respiratory distress
❑Venous congestion(svc syndrome)
❑Hoarseness of voice(due to compression over recurrentlaryngeal nerve)
❑Dysphagia ,due to esophageal compression
❑Horner’ syndrome, due to compression over sympathetic chain
❑Scabbard trachea
❑Later diaphragmaticparalysis may occur
❑Pleural effusion
❑Haemorrhage,due to erosion of major vessels by malignantcyst.
10. TREATMENT
▪ Surgical resection is the treatment of choice for most
mediastinal cyst. In particular, it is the treatment of choice
for foregut,gatroentericand neurentericcyst of the
mediastinum. The entire cyst wall should be resected to
preventrecurrence.In many cases , a portion of the cyst
wall may be densely adherentto adjacent structures,
usually the tracheobronchial tree or the esophagus. In case
, removal is impossible the mucosal linning should be
removed from the portion of cyst wall left within the
mediastinum to preventrecurrence.
11. ▪ Video-assisted thoracoscopic surgery(VATS) is used by thoracic
surgeons in the treatment of a number of mediastinal diseases. It has
been successfully used to resect a variety of mediastinal cyst. If not
accomplished by means of VATS ,standard thoracotomy should be
used.
12. CONTRAINDICATION FOR SURGERY
1. Pleuropericardial cysts,lymphogenous cyst and simple mediastinal
cyst, provided that an accurate non-surgical diagnosis has been
performed
2. Some cases of bronchogenic cysts found in adults in which cyst is
small and patient has no symptoms.
