Between January 1993 and June 2003, 106 patients underwent surgical treatment of a mediastinal mass. Ages ranged from 6 months to 62 years, with peak incidence in the third and fourth decade of life (56%). The male to female ratio was 1.9:1. The anterosuperior mediastinum was involved in 76 patients (72%), middle mediastinum in 13 (12%), and posterior mediastinum in 17 (16%). Myasthenia gravis was present in 27% of cases. Complete surgical excision was possible in 68% of patients. Histopathologically, 41 (39%) patients had thymic pathology, 31 (29%) had lymphoma, 14 (13%) had germ cell tumors, 12 (11%) had neurofibroma, 4 (4%) had ganglioneuroma, 2 (2%) had bronchogenic cyst, and 1 each had thymic cyst and mesothelioma. The overall mortality was 3.8%.

Spontaneous bronchoesophageal fistula in adults is a rare clinical entity. Most bronchoesophageal fistulae are due to malignancy, prolonged endotracheal intubation or trauma. Granulomatous infections like tuberculosis, HIV and mediastinitis are rare causes of acquired bronchoesophageal fistula. We report a case of a 50 year old man, treated for pulmonary tuberculosis 15 years ago, who developed a spontaneous bronchoesophageal fistula between the mid-esophagus and right main stem bronchus, having no history of malignancy or trauma. Surgical closure of the fistula was done and post operative recovery was uneventful. In this case, the bronchoesophageal fistula probably developed as a delayed sequela of pulmonary tuberculosis as the patient had no active signs of pulmonary tuberculosis clinically or histopathologically.A 50 year old male chronic smoker was referred to us with history of paroxysms of cough and expectoration following intake of liquids and intermittent fever since 3 months. Patient had pulmonary tuberculosis 15 years ago for which he was treated and became asymptomatic after that. Patient had no history of trauma, prolonged mechanical ventilation or malignancy. On examination patient had tachycardia, mild pallor and bilateral basal crepitations on chest auscultation. Blood counts and erythrocyte sedimentation rate were normal. Chest X-ray was normal except for prominent bronchovascular markings in the right mid-zone. Three successive sputum examinations for acid fast bacilli were negative. A barium swallow showed a fistulous communication between the midesophagus and the right main stem bronchus (Fig. 1). Upper GI endoscopy confirmed the fistulous communication between esophagus and right main stem bronchus 28 cm from incisors. CT scan of the chest showed no evidence of active tuberculosis in the patient other than fibrotic foci and hilar and mediastinal lymphadenopathy. The patient was subsequently explored via a right anterolateral thoracotomy through the fifth intercostal space. The mid-esophagus was dissected, incised longitudinally with a 4 cm incision and communication with right main stem bronchus identified by instilling saline in the open esophagus (Fig. 2). Due to extensive fibrosis and adhesions in the posterior mediastinum, dissection and excision of the fistulous tract were not attempted.

Chondrosarcoma of the chest wall is a rare primary neoplasm found to occur in elderly men. Patients present with an enlarging, painful, anterior chest wall mass arising from either the vicinity of the costochondral junction or the sternum. Treatment includes wide resection with appropriate chest wall reconstruction. We report an unusual presentation of this uncommon tumor occurring as a huge chest wall mass in a young teenage girl.

Bronchogenic cysts are congenital abnormalities of the bronchial tree and present with a wide range of clinical and radiologic manifestations. Asymptomatic bronchogenic cysts may become symptomatic and produce complications with passage of time. Therefore, removal of the cyst is advised. We present a case that was diagnosed as asymptomatic bronchogenic cyst. Therapeutic drainage of cystic fluid through a bronchoscope was attempted, which led to rupture of the cyst and leakage of cystic fluid into the mediastinum and pleural space, leading to complications. Finally, thoracotomy was performed, and the bronchogenic cyst was surgically removed. After surgery, the patient recovered completely. It has been concluded that transbronchial aspiration of cystic fluid may be an ineffective procedure and may lead to complications and require surgical intervention.

No abstract