This is the first report of a benign anterior mediastinal cyst causing either superior vena cava syndrome or middle lobe 
syndrome or both simultaneously said an article in cardiothoracic surgery journal, May 2008 issue. A case report of 66 year old woman admitted to hospital due to symptoms and clinical and radiological signs of simultaneous obstruction of superior vena cava and middle lobe of right lung secondary to compression by a massive benign anterior mediastinal cyst.
Then, excision of the cyst at median sternotomy resulted in complete resolution of all symptoms. The report seemed unusual for the concomitant presence of superior vena cava and middle lobe syndromes caused by a benign cyst because of its sheer size producing obstruction of these structures, and after removing the cyst, all symptoms and signs was completely carried out. Thus, benign anterior mediastinal cysts are unknown to cause either of the two syndromes.
This 66 year old woman had an hypertensive and asthmatic chronic smoker. She showed a progressively increasing shortness of breath for about 8 months. Other finding revealed an anxious, tachycardic woman, breathless at rest with engorged neck veins, purple discolouration of face, swelling of face and neck and wheeze over whole of right chest. A large mediastinal mass occupying right middle and lower zones of chest with an atelectatic middle lobe showed in chest X-Ray. An MR scan showed a large cystic mass 11 × 11 × 8 cm in the right anterior hemithorax quite likely to be a pericardial cyst. Echocardiography revealed an extracardiac mass abutting the right atrium and ventricle and TOE, the presence of a huge anterior mediastinal mass was confirmed on operation table.
After underwent a median sternotomy and found a large cyst of 15 × 10 × 8 cm, her facial swelling, rubescent discolouration and venous distension resolved, tachycardia disappeared and shortness of breath improved dramatically. Chest X ray showed near complete expansion of right lung and she was discharged home 7 days after her operation. And 6 weeks later, she was completely asymptomatic.
In the summary, these researchers from Yorkshire Heart Centre, Leeds General Infirmary, Great George Street, Leeds stated:
Even though benign anterior mediastinal cysts are not known to cause either of the two syndromes, it was the sheer size and the weight of the cyst that was responsible for causing such significant obstruction of both of these vital anatomic structures. Removal of the cyst resulted in instantaneous relief of both obstruction of superior venacava and the compressive atelectasis of middle lobe and medial basal segments of the right lower lobe.
Pankaj Kaul, Kalyana Javangula, Shahme A Farook were the authors of the original article. Find A Case Report Journal : Massive Benign Anterior Mediastinal Cyst Caused Syndrome from its original tittle and site here. Six pages of Pdf filetype and were riched by intraoperative mass photograph , x-ray, echocardiogram, and CT scan (source: cardiothoracicsurgery.org). Find another Surgery Journal you may fit.
