Urgent Surgical Approach to Mediastinal Cyst Causing Life-Threatening Tracheal Obstruction

This case describes an urgent surgical approach to a patient with symptoms of rapid progressive respiratory compromise resulting from a massive mediastinal cyst. To relieve tracheal compression, ultrasound-guided percutaneous fine-needle aspiration was performed as an urgent procedure, which immediately improved the patient's airway obstruction and facilitated double-lumen endotracheal intubation. Methylene blue was injected into the cyst through the puncturing needle and accurately marked the margins of the cyst. The cyst was completely resected under thoracoscopy. The signs and symptoms of airway obstruction resolved after the operation, with no recurrence observed during the 1-year follow-up. (C) 2018 by The Society of Thoracic Surgeons