A 65-year-old woman, a non-smoker, presented to the pulmonary medicine outpatient department with chest pain, mild dyspnoea, right side neck swelling and mild facial puffiness. The cervical swelling was soft, non-tender and fluctuant on palpation. Multimodality imaging revealed a large, thin-walled cervicomediastinal cystic lesion with septations, haemorrhage, septal calcification and without any solid component. Image-guided fine-needle aspiration cytology from the septa with immunocytochemistry helped to establish the thymic origin and benign nature of the cyst preoperatively and differentiate it from cystic thymoma, lymphangioma, thymic carcinoma or lymphoma with confidence. As the haemorrhage resolved, the size of the swelling was significantly reduced, and the patient became asymptomatic due to which she deferred surgery but remained on close follow-up and was doing well. Thymic cysts can occur in a cervicomediastinal location, rare in elderly age, usually asymptomatic and clinically apparent when intracystic haemorrhage leads to an increase in size and chest pain.
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Contributors SM: drafting the manuscript, literature search, radiological imaging and collection of images; MS: review of manuscript, pathological diagnosis, collection of images and follow-up; SN: review of manuscript, radiological imaging and collection of images; PRM: review of manuscript, clinical details of the patient and follow-up.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.