Primary cardiac spindle cell sarcomas are extremely rare and have poor prognosis. Complete surgical resection represents the only treatment option proven to work. We report a case of a 28-year-old man who was referred to our cardiothoracic unit with a right ventricular mass extending to the main pulmonary artery with a provisional diagnosis of a thrombus or a right ventricular myxoma. He sought medical attention after experiencing shortness of breath, cough, chest pain, abdominal pain and bilateral leg swelling for about 6 weeks. Two dimensional transthoracic echocardiogram showed a mass arising from the right ventricle and extending into the main pulmonary artery; findings that were confirmed with contrast chest CT scan.He underwent extensive resection of the mass and had uneventful postoperative period with immediate symptomatic relieve. He is on adjuvant chemotherapy using vincristine, adriamycin and cyclophosphamide (VAC). Right ventricular sarcoma is a very rare cause of right sided heart failure, a very aggressive tumour whose only chance of successful treatment is complete surgical excision.

IntroductionComplex embryological processes form the head and neck of humans. It is not flawless; remnants lead to sinuses or cysts, commonly in the head and neck region.Case presentationWe present the a case of an 8-year-old boy, a primary school pupil, from rural Kenya with chronic cough, wheezing, difficulty in breathing and dyspnea on exertion. He was treated with antibiotics and antitubercular drugs without improvement prior to referral to our hospital. A computed tomography scan of his chest revealed a superior mediastinal mass extending into his neck. A diagnosis of a brachial cleft cyst was made and our patient underwent a successful excision of the mass through a median strenotomy and neck dissection.ConclusionsBranchial cysts of the neck are common, accounting for 20% of pediatric neck masses. Usually they present as a neck mass but in our case it presented as a mediastinal mass, which is a very rare clinical presentation. Surgical excision is the mainstay of treatment. To the surgeon, the embryology and anatomy should be absolutely clear as dissection may be challenging due to the close proximity and variable course of the cystic stalk to major neck vessels and nerves.