Mediastinal bronchogenic cysts are usually identified on computed tomography (CT) as well-defined masses of variable density that may contain rim calcifications. Pleural effusion has never been described in association with these cysts.We report two cases of bronchogenic cysts with unusual presentation because of an association with a pleural effusion not explained by pulmonary infection. The patients were studied with CT scan (n=2) and magnetic resonance imaging (MRI) of the chest (n=1).In the first case, the pleural effusion directed diagnosis towards lung tumour; and the diagnosis of bronchogenic cyst was made on thoracotomy. In the second case, bronchogenic cyst was suspected on MRI findings. Inflammatory reaction was also suspected on the CT scan, which showed enhancement of the cyst edge.In both cases, surgical excision of the cyst was difficult because of pericystic adhesions to adjacent organs. Therefore, solely on the finding of a pleural effusion, pericystic inflammation had to be suspected. Eur Respir J., 1995Respir J., ., 8, 2185Respir J., -2187 Bronchogenic cysts are congenital abnormalities resulting from embryological budding of the bronchial tree; they often arise near the carina [1][2][3]. Mediastinal bronchogenic cysts are frequently detected incidentally, on routine chest radiographs. They manifest as smooth and well-circumscribed masses near the carina [2,3].We describe two cases of bronchogenic cyst that appeared as mediastinal mass with pleural effusion, without pulmonary infection. To our knowledge, this radiological manifestation, in association with bronchogenic cyst, has not previously been reported. Case reports Case 1A 49 year old man presented with a one month history of dysphagia. Chest radiography revealed right mediastinal mass and ipsilateral pleural effusion. Oesophagoscopy revealed a marked extrinsic compression of the oesophagus. Fibreoptic bronchoscopy showed an infiltration of the mucosa of the right intermediate bronchus.Biopsies were negative.Chest computed tomography (CT) scans showed a mediastinal tumoral mass with tissular density (35 Hounsfield units (HU)) and a right pleural effusion ( fig. la and b). CT guided needle biopsies were negative. The diagnosis of necrotic mediastinal malignancy with pleural effusion was suspected. Fig. 1. -Case 1. a) Computed tomography (CT) scan 10 mm thick slice, medistinal windows, shows the mass behind and under the carina, associated with a right pleural effusion. b) Lower level; the mass does not enhance after contrast media injection. Enhancement of its right edge is probably related to inflammatory mediastinal pleura or to a lung collapse around the mass. Right pleural effusion is apparent.

We report a case of adult-onset Still's disease (AOSD) revealed by pleuropericardial manifestations. A 40 yr old black woman was admitted for flu-like syndrome with pharyngitis, hectic fever, polymorphonuclear hyperleucocytosis and pleuropericarditis. The diagnosis of AOSD was supported by 3 major and 3 minor criteria after exclusion of infectious, haematological and connective tissue diseases. Pulmonary involvement is infrequent in AOSD, and consists of transient pulmonary infiltrates and chronic restrictive pattern. However, pleuritis, like pericarditis, is present in 25% of cases. Initial onset of pleuritis, associated with fever and hyperleucocytosis preceding articular manifestations could be responsible for a delay in diagnosis and a subsequent worsening in the prognosis of the disease. A rapid improvement is usually observed under nonsteroidal anti-inflammatory drug or corticosteroid treatment.