Her CECT (contrast enhanced CT scan Neck and Chest) (Figure-2) revealed a lobulated cystic lesion present anteriorly in the root of neck, extending down into antero-superior mediastinum
, containing islands of fat, measuring 17x 12x13cm, compressing thyroid gland, trachea, great vessels especially SVC, with collateral formation, suggestive of germ cell neoplasm/thymic mass.
Thereafter, the air passes to mediastinum
which is connected to retropharyngeal space and finally free air reaches to epidural space.
Thymus is an important organ housed in the anterior mediastinum
and thymoma is the most common tumour of the thymus with an incidence of 0.15 per 100, 000 person years.
The lymph node metastasis rate of upper-thoracic ESCC into the upper mediastinum
was 34.0% which was significantly higher than those of mid-(6.5%) and lower-thoracic tumors (3.3%) (P<0.05).
An increase of linear-type transparency starting from the right paratracheal area and extending to the mediastinum
, and a subcutaneous emphysema in the neck region were observed on the posteroanterior (PA) chest X-ray of the patient (Figure 1).
Subsequently, a CT scan of the thorax and abdomen showed a 2 cm, hyper-vascular, solitary nodule at the anterior mediastinum
, at the level of the anterior aspect of the ascending aorta (Figure 1).
The space of the mediastinum
is narrow and any mass in this region can compress adjacent structures leading to emergencies that threaten life .
A chest roenterogram disclosed a round, smooth mass in the left upper border of the mediastinum
As there is no fascia between the posterior mediastinum
and the retropharyngeal and epidural space, air can freely diffuse into the epidural space via the posterior surface due to lower resistance.
Bronchogenic cysts, esophageal cysts, and pericardial cysts are some of the congenital cysts of the mediastinum
. Thymic cysts and dermoid cysts can be given as an example to acquired cysts of the mediastinum
The patient underwent exploration of the lower neck and upper anterior mediastinum
by a cervical approach.
Cysts arising in the mediastinum
are relatively rare, accounting for 12-30% of mediastinal masses (1).
Endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive and safe technique which is universally accepted for the mediastinum
and/or hilum lymph node biopsy.
Pericardial cysts are uncommon benign congenital anomalies located in the mediastinum
. They typically present in the middle mediastinum
, representing approximately 33% of mediastinal cysts and 6-7% of mediastinum
It may also occur in less frequent sites such as the esophagus, mediastinum
, heart, adrenal glands, and pancreas .