The mediastinum is an area of the body in which a wide range of tissue variability exists. Therefore, tumors and cysts that occur in this area can represent many different clinical entities and pathologic processes.
An understanding of the embryology of this area and of the anatomic relationships of the normal structures within the mediastinum are essential in the proper determination of the exact nature of a mass or tumor located in this area.
Treatment selection for a given mediastinal tumor or cyst depends on the diagnosis of the lesion being investigated. Surgical resection is indicated in a large percentage of cases.
Surgical resection is indicated for most mediastinal cysts. All large and symptomatic bronchogenic cysts are included in the group, as are all enteric gastroenteric and neurenteric cysts.
Some authors do not recommend resection of small asymptomatic bronchogenic cysts, while others advise aspiration of such cysts and resection only for those with symptoms or recurrence. Excision of pleuropericardial cysts and simple mesothelial cysts is indicated for diagnostic purposes only. Thymic cysts require excision or enucleation. Thoracic duct cysts require excision and accompanying ligation of the thoracic duct.
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