Mediastinal carinal bronchogenic cyst: is its mere presence an indication for surgical excision?

A notion has prevailed that carinal bronchogenic cyst and other congenital mediastinal cystic lesions, particularly those occurring in older children and adults, are usually asymptomatic, innocuous, and frequently only an incidental finding on routine chest roentgenogram or postmortem examination. Some physicians, therefore, have adopted a policy of observation for these patients. Our experience, however, as demonstrated in three cases reported herein, and the experience of others, clearly shows that carinal bronchogenic cyst is far from being usually asymptomatic and innocuous, but in fact often produces a broad spectrum of clinical manifestations, some of which are life-threatening. Mere observation not only places these patients at serious risk, but also increases the possibility of missed diagnosis and delayed treatment of those lymphoproliferative malignancies involving mediastinal lymph nodes that can mimic a carinal bronchogenic cyst. Computerized tomography (CT) is the single most important method of making a diagnosis of carinal bronchogenic cyst. We believe strongly that the mere presence of a mediastinal carinal bronchogenic cyst is an indication for surgical excision.