A Case of a Giant Cystic Mediastinal Lesion With Complete Unilateral Atelectasis Treated by a Two-stage Surgical Strategy

Abstract

We report a case of a 1-year-old boy with a giant cystic mediastinal lesion causing complete left lung atelectasis. The patient presented with severe respiratory distress due to compression of the left main bronchus by a large cystic lesion. To avoid catastrophic airway collapse during anesthesia induction, right thoracotomy and cyst drainage were initially performed to decompress the lesion and re-expand of the left lung. After respiratory and circulatory stabilization, the cyst was definitively excised ten days later. His postoperative course was uneventful, and histopathological examination confirmed a bronchogenic cyst. Mediastinal cystic lesion presenting with complete unilateral atelectasis poses a high anesthetic risk due to airway compression and ventilation difficulty. In such cases, a staged surgical approach consisting of initial decompression followed by complete excision allows for safe airway management and favorable outcomes. This strategy is particularly valuable for pediatric patients with compromised ventilation caused by large mediastinal cysts.