Differential diagnosis of mediastinal cysts: a case series.

Background: Mediastinal cysts are common mediastinal lesions in which diagnostic and therapeutic choices are not always unambiguously presented. Usually, these cysts are asymptomatic and detected by coincidence. The question remains whether, if symptoms are present, the cyst is responsible and whether it should be treated. Unfortunately, there is a lack of standardised guidelines concerning diagnostic, therapeutic management and follow-up.

Case summary: In this case series we reported five patients with mediastinal cysts. All patients received a thoracic CT during the initial diagnostic assessment. Four out of five patients were symptomatic and were surgically treated during a uniportal video-assisted thoracoscopy. One patient was asymptomatic and receives a biennial follow-up. Most often, histopathological examination confirmed the already presumed type of non-neoplastic mediastinal cyst based on anatomical location and tissue characteristics (one thymic cyst, one bronchogenic cyst and two pericardial cysts). Except for one patient, all surgically treated patients experienced improvement in symptoms.

Conclusion: Regarding diagnosis and treatment of this entity, a systematic approach in accordance with the most recent literature is important. The diagnosis can only be confirmed on histopathological examination, but several imaging techniques, with contrast-enhanced CT as the first-choice technique, could guide the differential diagnosis. In large, symptomatic cysts or present potential malignant features, surgical removal is indicated. This case series encourages further substantial research concerning the selection and timing of therapy.