PMC6831818_01
Preoperative images.. A, B. Chest computed tomography. A mediastinal mass was noted in the subcarinal space (*). Compression of the right pulmonary artery (short arrow) and airway (arrowhead). Delayed enhancement of the right pulmonary vein and airway was seen at the tracheal bifurcation (long arrow). (A: Axial, B: Coronal).. C, D. Fat-suppressed T2-weighted magnetic resonance imaging. A two-layered simple cyst (*) was observed, which indicated infection or bleeding inside the cyst. (A: Axial, B: Sagittal).
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Enhanced computed tomography (CT) scan revealed a mediastinal mass in the subcarinal space, which compressed the right pulmonary artery and a delayed right pulmonary vein and airway enhancement at the tracheal bifurcation (Fig. 1-A, B). To ensure that the mass was a simple cyst without septum and mural nodule, magnetic resonance imaging (MRI) was performed as the patient's condition allowed; the image showed a two-layered simple cyst, which indicated an infection or bleeding inside the cyst (Fig. 1-C, D).
Operative findings.. A. The cyst wall appeared on the subcarinal lesion (*) after the dissection of mediastinal pleura.. B. We inserted a drainage tube through the cyst after cyst wall fenestration on subcarinal lesion (arrowhead) and superior mediastinum (arrow).. C. Aspirated white pus after cyst puncturing.. D. Fluid inside the bottom layer of the cyst. Both pus and blood were found.
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The bottom layer fluid inside the cyst contained both pus and blood, which were compatible with MRI findings, while continuous bleeding from the cyst wall was not observed (Fig. 2).
Pathological findings of the cyst wall (hematoxylin and eosin stain). Bronchial gland (*), cartilage (**) with infiltration of inflammatory cells.
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Pathological examination of the cyst wall revealed an inflamed bronchogenic cyst with the findings of bronchial gland, cartilage with infiltration of inflammatory cells, and no malignancy (Fig. 3).