Complete thoracoscopic excision of an infected bronchogenic cyst due to mediastinitis

Abstract

Because bronchogenic cysts can result in infection, further complications due to compression of adjacent organs or malignant transformation, symptomatic and complicated bronchogenic cysts are usually surgically removed. However, surgical excision can be hazardous or incomplete because of dense adhesion to surrounding vital organs as a consequence of severe inflammation. Herein, we report a rare case of infected bronchogenic cyst caused by mediastinitis and we describe how a surgical approach using video-assisted thoracoscopic surgery (VATS) should be considered for treatment, even among patients with complicated bronchogenic cysts.

Keywords: Bronchogenic cyst; mediastinitis; video-assisted thoracoscopic surgery (VATS).

Figure 1

Preoperative chest CT (A,B) revealed cellulitis with fluid collection in the right anterior neck and a rim-enhancing cystic lesion (6.2 cm × 3.8 cm × 2.8 cm) in the anterosuperior mediastinum with peri-lesional infiltration deviating the trachea leftward, suggesting an infected mediastinal cyst accompanying acute mediastinitis and deep neck infection.

Figure 2

The cyst was well encapsulated and contained whitish pus (A). The thymus and the cystic mass were completely excised using video-assisted thoracoscopic surgery (B). Postoperative chest CT (C) showed no visible recurrence of cystic lesions or complications.