PMC3329068_01
(a) Photograph of the neck without Valsalva maneuver demonstrates
no neck mass. (b) Neck mass is observed when patient is asked to perform Valsalva maneuver
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F1
The neck swelling only appeared when the patient was asked to perform Valsalva maneuver [Figures 1a and b].
Grayscale Ultrasound of neck in transverse view (a) without Valsalva maneuver and (b) with Valsalva maneuver demonstrates a cystic mass with internal low level echoes.
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F2
High-resolution sonography of the neck with the child performing Valsalva maneuver showed a well-circumscribed cystic mass with lobulated outlines, multiple small echogenic foci, and linear echogenic lines in the midline of the lower neck anterior to the cervical trachea [Figure 2].
MRI Saggital T1WI images show hypointense and T2WI hyperintense cystic lesion in the anterior mediastinum (a, b) without Valsalva maneuver and (c) with Vasalva maneuver.
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F3
MRI showed a cystic suprasternal mass continuous with the normal thymus in the anterior superior mediastinum [Figure 3].
Intraoperative images (a) Partial sternotomy with excised thymus. (b) Complete specimen and the cut open cyst. (c) Closed cervical and sternotomy surgical incision.
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F4
Intraoperatively a cystic lesion from the thymus extending to the lower neck was seen and excised [Figure 4].
Histopathology reveals the cyst wall with thymic tissue (white arrow), lymphoid aggregates (black arrow) and Hassals corpusceles (dashed arrow) (H and E, -100).
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F5
Histopathology revealed the lesion to be a thymic cyst [Figure 5].