P-224MEDIASTINAL BRONCHOGENIC CYST WITH ACUTE CARDIAC DYSFUNCTION: A TWO-STAGE SURGICAL APPROACH

• Published in: Interactive cardiovascular and thoracic surgery Vol. 18; no. suppl_1; pp. S58 - S59
• Main Authors: Smail, Hassiba, Baste, J.M., Canville, A., Rinieri, P., Melki, J., Peillon, C.
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01.06.2014
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivu167.224

Objectives: We describe a two-stage surgical approach to rescue a patient presenting with cardiac dysfunction and haemodynamic compromise due to a massive and compressive mediastinal bronchogenic cyst. Case description: A 66-year-old man presented with acute onset of palpitations and severe dyspnoea. On admission the electrocardiogram showed atrial fibrillation, the chest X-ray showed round density in the posterior mediastinum and pleural effusion. A transthoracic echocardiography revealed pericardial tamponade. The patient underwent echocardiographic-guided drainage of his pericardial effusion, without improvement in the cardiac function. A chest computed tomography revealed a 10-cm, well-defined subcarinal cyst causing significant compression of the left atrium, left pulmonary artery and carina. This compressive cyst compromised the haemodynamic state, which increased the risk of open surgery. Therefore, to drain this mediastinal cyst, a video-assisted mediastinoscopy was performed in emergency through a cervical incision, and after dissection of the pre-tracheal plane, we aspirated 1.5 l of white yellow viscous fluid, which improved immediately the cardiac function. We declined excision of the cyst margins due to the risk of atrial fibrillation exacerbation. Five days later and under video thoracoscopy we tried to resect the cyst margins. They were found to be tightly adherent to the left atrium and resection was impossible; therefore, we decided to convert to a right thoracotomy and performed de-roofing of the superior aspect of the cyst to prevent recurrence. Histological examination revealed ciliated stratified epithelium characteristic of a bronchogenic cyst. The patient had uncomplicated postoperative recovery and was discharged 6 days later. After 6 months, the patient remained asymptomatic and a CT scan showed no recurence. Conclusions: Video-assisted cervical mediastinoscopy was particularly useful in the emergency management of this compressive bronchogenic cyst with haemodynamic compromise. To avoid recurrence, a second surgery was necessary to resect the cyst margins. Disclosure: No significant relationships.