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A 56 year old man presented with dyspnoea, cough, palpitations, and substernal chest pain for five months. He had jugular venous distension and ascites on examination. In addition the liver was palpable, and the extremities were oedematous. Echocardiography revealed pulmonary cardiac compression. Posteroanterior radiography of the chest revealed an enlargement of the mediastinum with pulmonary and cardiac compression (panel below). Contrast enhanced axial computed tomography (panel A), sagittal reconstruction image (panel B), and coronal reconstruction image (panel C) showed a water dense large mass measuring 34 × 25 × 16 cm, causing cardiac and vascular compression, in the anterior mediastinum. Multislice computed tomography (panel D) revealed bilateral pulmonary parenchymal compression caused by the large mass. An emergency operation was performed. The cyst was thought to be thymic, and was completely removed via a median sternotomy. Histological examination of the resected specimen confirmed that it was a thymic cyst. The patient received assisted ventilation with limited peak airway pressures for six hours during the postoperative period. He had an uneventful recovery and was discharged home eight days after surgery. He was doing well at the four month follow up visit.
Thymic cysts of the mediastinum are a distinct clinical entity that must be considered when treating a patient with a huge mediastinal mass. Because these cysts can compress vital structures they should be treated without delay.