Anesthetic management of a patient with a mediastinal foregut duplication cyst: a case report

Foregut duplication cysts are rare. There is no mention of this type of mediastinal mass in searches of the anesthesia literature. A 42-year-old woman undergoing preoperative evaluation for elective bilateral breast augmentation was found by chest radiograph to have a mediastinal mass. She was referred for additional evaluation. After thorough radiographic and physical examination, the patient underwent successful resection of a foregut duplication cyst that involved esophageal, right lung, pericardial, and subcarinal tissues. The location of the foregut duplication cyst, its mass effect, and the anatomical structures involved with the cyst may present numerous challenges for anesthesia providers. Airway management, arterial cannulation, and central venous access may be difficult. In addition, patients with foregut duplication cysts are at risk for pneumothorax, pneumomediastinum, profound hemorrhage, esophageal injury or rupture, vascular lesions, neurologic injury, gastric aspiration, and cardiovascular collapse due to anatomical disturbances caused by the mass. Comprehensive evaluation and development of an anesthetic plan based on this evaluation will improve patient outcome and help prevent potentially catastrophic complications.