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A 35-year-old man, normotensive, nondiabetic, a nonsmoker, and army personnel, presented with swelling on the right side of the neck, which appeared only after exercise or with exertion for the previous 6 months. The swelling was not associated with pain or difficulty with breathing or swallowing. He had no history of foul breath, regurgitation of food, trauma to the neck, or any surgical procedure. On examination, the swelling was not visible; however, it appeared when performing the Valsalva maneuver. It was soft, cystic, nontender, and compressible on palpation and measured approximately 3 × 1.5 cm at maximum expansion ( Figure 1A). There was no bruit on auscultation, and the swelling was not transilluminant.

Mediastinal teratomas are usually asymptomatic tumors, located most commonly in the anterior mediastinum. Very rarely, such tumors may rupture into the tracheobronchial tree, lung, pleura or pericardium. Computed Tomography (CT) is helpful in the diagnosis and differentiation of ruptured and unruptured tumors.We report a case of ruptured anterior mediastinal teratoma in a 20-year-old female presenting with recurrent hemoptysis and cough; thus, mimicking a lung malignancy or tuberculosis. CT demonstrated a heterogeneous fat containing lesion in the anterior mediastinum with extension into the lingular lobe. Subsequent fine needle aspiration cytology (FNAC) yielded plenty of anucleate squames and debris, and a clear cut diagnosis could not be made. Total excision of the tumor was performed and histopathology of the surgically excised mass confirmed the CT diagnosis.