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• W2133999982 abstract "A 78-year-old woman was referred for assessment of a non-productive cough and abnormal findings on chest roentgenogram. Physical examination showed a healthy-looking elderly woman with no abnormal chest findings. A PA chest film showed a 4 cm rounded mass just below the right hilum (Fig 1). A lateral film (Fig 2) identified a prominent mediastinal mass. Review of old films confirmed that this lesion had been present and unchanged for five years. Tomograms and a CAT scan of the thorax outlined a noncalcified mass in the retrocardiac space. At fluoroscopy, this mass was nonpulsatile. The patient declined further investigation. Two years following initial presentation, she experienced a sudden paroxysm of coughing and produced a large amount of mucoid sputum. A subsequent chest x-ray film (Fig 3, lateral view) showed that the lesion had disappeared. The patient remains clinically well with no further roentgenographic changes two years following this episode.Figure 2(upper)View Large Image Figure ViewerDownload (PPT)Figure 3(lower)View Large Image Figure ViewerDownload (PPT) The differential diagnosis of a middle mediastinal mass includes developmental abnormalities such as bronchogenic cyst or mesothelial cyst, malignancies such as lymphoma and metastatic tumor, traumatic lesions and vascular anomalies.1Fraser R.G. Pare J.A.P. Diagnosis of diseases of the chest. 2nd ed. WB Saunders, Philadelphia1977Google Scholar The benign clinical course, lack of roentgenographic change over several years, and the sudden disappearance of the mass after expulsion of its contents into the tracheobronchial tree are most compatible with the diagnosis of bronchogenic cyst. Bronchogenic cysts develop in the pulmonary parenchyma or mediastinum as the result of abnormal budding of the ventral diverticulum of the foregut between the 26th and 40th days of intrauterine life.1Fraser R.G. Pare J.A.P. Diagnosis of diseases of the chest. 2nd ed. WB Saunders, Philadelphia1977Google Scholar These thin-walled cysts are lined with respiratory epithelium and usually contain mucoid material. The wall of the cyst may also contain cartilage plates, muscle and elastic fibers. The respiratory epithelium lining bronchogenic cysts may be destroyed by infection making it difficult to distinguish them even pathologically from acquired cysts such as those produced by lung abscess.2Spencer H. Pathology of the lung (excluding pulmonary tuberculosis). 3rd ed. WB Saunders, Philadelphia1977Google Scholar Calcification of the cyst wall is uncommon. Although peripheral cysts are often multiple and may communicate with the parent bronchus, mediastinal cysts are more commonly single and without communication with the airway.3Maier H.C. Bronchogenic cysts of the mediastinum.Ann Surg. 1948; 127: 476-502Crossref PubMed Scopus (151) Google Scholar,4Reed J.C. Sobonya R.E. Morphologic analysis of foregut cysts in the thorax.Am J Roentgenol. 1974; 120: 851-860Crossref Scopus (51) Google Scholar Bronchogenic cysts are more likely to communicate with the tracheobronchial tree when infected, at which time air may enter the cyst. Approximately 75 percent of cysts eventually become infected. Bronchogenic cysts, particularly those in the mediastinum, seldom produce symptoms until infected when the patient may present with cough, fever and hemoptysis.5Rogers L.F. Osmer J.C. Bronchogenic cyst: a review of 46 cases.Am J Roentgenol. 1964; 91: 273-283Google Scholar,6Baum G.L. Racz I. Bubis J.J. Molho M. Shapiro B.L. Cystic disease of the lung; report of eighty-eight cases, with an ethnologic relationship.Am J Med. 1966; 40: 578-602Abstract Full Text PDF Scopus (9) Google Scholar The presence of a bronchogenic cyst may be unsuspected during acute infective episodes if the surrounding lung parenchyma is consolidated, thereby obscuring the sharp outline of the rounded cyst. In the absence of infection, mediastinal cysts may produce severe respiratory distress or hemodynamic embarrassment in infants by compression of the major airways or great vessels." @default.
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• W2133999982 title "Spontaneous Disappearance of a Chronic Mediastinal Mass" @default.
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• W2133999982 doi "https://doi.org/10.1378/chest.87.2.235" @default.
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