Case 34

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Clinical History:
The patient was an eleven year old male with upper respiratory symptoms and wheezing who had a past medical history remarkable for esophageal atresia and tracheoesophageal fistula, repaired in infancy.

Clinical Physical Exam:
Wheezing

Clinical Labs:
Non-contributory

Clinical Differential Diagnosis:
Airway obstruction

Imaging Findings:
Chest film showed a superior mediastinal mass. A barium swallow (not provided) showed the esophageal anastomosis to be widely patent, and the mass was noted to be retrosternal in position. A chest CT exam showed a cystic structure in the anterior mediastinum.

Images 1 and 2

Image 3

Imaging Differential Diagnosis:
Thymic cyst

Operative Findings:
The patient was taken to the operating room electively several days later. A cystic mass was removed from the anterior mediastinum.

Pathological Findings:
Pathological examination of the mass revealed findings characteristic for a thymic cyst.

Final Diagnosis:
Thymic Cyst

Follow-up and Prognosis:
The patient had an uncomplicated post-operative course. Post operatively his wheezing disappeared, apparently the cyst had pushed the great vessels against the trachea and caused the wheezing.

Similar Cases:
Case 33, Case 37, Case 38, Case 39, Case 40, Case 41, Case 60

References:

• International Thoracic Teaching Resource - http://www.vh.org/adult/provider/radiology/ITTR/ThymicCyst/ThymicCyst.html

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