[Resection of bronchogenic cyst by video-mediastinoscopy]

A bronchogenic cyst is a congenital malformation originating from the ventral primitive gut. It may be located in the mediastinum or in the lung parenchyma. Its location depends on the stage of gestation in which it developed. Despite being a histological benign tumor, many authors recommend its complete excision in order to obtain histological confirmation and to prevent future complications. The traditional approaches for excision are thoracotomy or video-assisted thoracoscopic surgery (VATS). However, a minimally invasive approach through vídeomediastinoscopy constitutes a valid alternative in selected cases. The authors present a case of a 23 years old female patient, admitted to the emergency department with retrosternal pain, dyspnea at rest, tachycardia, polypnea, infra-clavicular accessory muscle contraction, jugular vein distention and hypoxemia. A Chest CT revealed a large cystic lesion of the middle mediastinum, with compression of the vascular structures, deviation of the tracheobronchial tree and reduction in the diameter of the main bronchi. The patient was referred for surgical treatment. A mini-cervicotomy incision was made, and with elevation of the sternum a video-mediastinoscope was introduced. With bimanual instrumentation, complete excision of a large mediastinal cyst of the middle mediastinum was performed. The cyst was located in the subcarinal and pre-tracheal space, had contact with the left and right main bronchi, esophagus, roof of the left atrium, pulmonary artery and superior pulmonary veins. The histological evaluation revealed a bronchogenic cyst. There were no immediate postoperative complications. The patient remains asymptomatic after two years of follow-up, and without recurrence.