A case of emergent operation for a life-threatening infectious mediastinal cyst

Highlights • Congenital mediastinal cysts are an uncommon but important diagnostic group. • Mediastinal bronchogenic cysts with life-threatening complications are rarely reported in adults. • The patient’s condition can be emergent due to airway and vascular compression in some cases. • We considered that the reason for this acute exacerbation was cyst bleeding because a two-layered cyst was observed on MRI. • Emergent surgical care should be considered in such life-threatening cases.
Purpose Congenital mediastinal cysts are an uncommon but important diagnostic group. Most of these cysts are benign and asymptomatic in adults. However, some of them are clinically problematic due to the compression of neighboring organs, infection, or perforation. Case presentation A 20-year-old man presented with severe dyspnea. Imaging revealed a mediastinal cyst in the subcarinal space compressing his right pulmonary artery and airway, which was later diagnosed as a bronchogenic cyst. Due to quick symptom exacerbation, emergent cyst wall fenestration was performed through video-assisted thoracic surgery with “stand-by” extracorporeal membrane oxygenation. Complete cyst resection was difficult owing to adhesion of the cyst to the surrounding organs. The symptoms immediately resolved after surgery and the postoperative course was uneventful. Conclusion Mediastinal bronchogenic cysts with life-threatening complications are rarely reported in adults. However, this case was life-threatening due to airway and vascular compression; emergent surgical care should be considered in such cases.