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A wide spectrum of pulmonary complications occurs in patients with pneumoconiosis. Those complications include chronic obstructive pulmonary disease, hemoptysis, pneumothorax, pleural disease, tuberculosis, autoimmune disease, anthracofibrosis, chronic interstitial pneumonia, and malignancy. Generally, imaging workup starts with plain chest radiography. However, sometimes, plain radiography has limited role in the diagnosis of pulmonary complications of pneumoconiosis because of overlapping pneumoconiotic infiltration. Computed tomography (CT), ultrasonography (US), and magnetic resonance imaging (MRI) are potentially helpful for the detection of pulmonary complications in patients with pneumoconiosis. CT, with its excellent contrast resolution, is more sensitive and specific method than plain radiograph in the evaluation of pulmonary abnormalities. CT is useful in detecting lung parenchymal abnormalities caused by infection, anthracofibrosis, and chronic interstitial pneumonia. Also, CT is valuable in distinguishing localized pneumothorax from bullae and aiding the identification of multiloculated effusions. US can be used in detection of complicated pleural effusions and guidance of the thoracentesis procedure. MRI is useful for differentiating between progressive massive fibrosis and lung cancer. Radiologists need to be familiar with the radiologic and clinical manifestations of, as well as diagnostic approaches to, complications associated with pneumoconiosis. Knowledge of the various imaging features of pulmonary complications of pneumoconiosis can enhance early diagnosis and improve the chance to cure.

Mature teratomas are the most common mediastinal germ cell tumors. Most mature teratomas are located in the anterior mediastinum, and only 3–8% of mature teratomas occur in the posterior mediastinum (1). Mature teratomas may rarely rupture into adjacent structures (2). Based on a review of the literature, ruptured mature teratomas in the posterior mediastinum have not been reported previously. Ruptured teratomas with invasion of adjacent structures, such as the pleural space, pericardium, or lung parenchyma, have rarely been reported, but all reported mediastinal mature teratomas have been located in the anterior mediastinum (2). In this case report, we noted an unusual tumor location and imaging findings of ruptured mature teratomas in the mediastinum. We present a case of ruptured mature cystic teratoma located in the posterior mediastinum with fistula formation of the adjacent lung and esophagus.