2023 Volume 37 Issue 7 Pages 600-604
A 68-year-old woman was referred for breast cancer 3 years ago. Preoperative MRI showed an anterior mediastinal cyst, which was suspected to be a thymic cyst. On follow-up, CT showed an enlarged cavity, thickened wall, and increased surrounding lipid density. We suspected infection of the cyst and planned surgery. As the cyst extensively compressed the left brachiocephalic vein, we considered a technique that would allow multidirectional manipulation as appropriate and performed robot-assisted surgery using a subxiphoid and bilateral thoracic approach. The cyst was safely dissected from the left brachiocephalic vein and resected without leakage of its contents. Pathological examination revealed inflammation and fibrosis in the cyst wall, and the diagnosis was thymic cyst. The postoperative course was uneventful, and she was doing well with no recurrence 6 months after the surgery.
Anterior mediastinal cysts are generally followed up without any treatment. In cases of inflammation, surgery is indicated and it is important to avoid mediastinitis and preserve the surrounding vital structures. In this case, a robot-assisted subxiphoid and bilateral thoracic approach contributed to surgical safety for a thymic cyst with suspected infection.
