Subcarinal foregut cysts. A unique clinical problem

To evaluate the risks associated with a subcarinal foregut cyst in a fixed mediastinal space.

Between January 1, 1986, and August 1, 1997, 8 patients who had subcarinal cysts and who underwent surgical intervention were identified. These results were analyzed to identify associated symptoms and results of surgical intervention. Mean duration of follow-up was 37.3+/-2.2 months and was 100% complete.

Of the eight patients, three were men. Mean age was 45.6+/-15.6 years (range 24-66). All patients were symptomatic. Six patient suffered respiratory distress. Four patients complained of chest pain. Preoperatively, all patients underwent routine chest radiography. Six patients underwent computed chest tomography (CT); 4 patients had magnetic resonance imagery (MRI) of the chest. Cardiac echocardiography was performed on 4 patients and esophagogastroduodenoscopy (EGD) with or without esophageal ultrasound (EUS) was done in 4. Of 7 patients who underwent bronchoscopy, 6 patients demonstrated extrinsic airway compression. The remaining patient showed fistulous communication.

Cyst dimensions ranged from 7.33+/-1 cm (mean+/-SD). Total resection of the cyst was accomplished in 6 patients. One patient with fistulization underwent right main bronchial sleeve resection. Histopathology revealed inflammation of the cyst in 2 cases and calcification of the cyst wall in 1. Fluid from one cyst grew gram positive cocci.

Length of hospital stay ranged from 10.9+/-4.4 days. There were no mortalities. Morbidity included prolonged ventilation (1), pulmonary embolism (1) and left recurrent laryngeal palsy (1).

Our results corroborate the need for surgical excision of subcarinal subtype cysts to prevent the development of mediastinal compression and other cyst-related complications.