Ruptured thymic cysts with mediastinal hemorrhage and hemothorax--a case report and reviews of the literature

We report a rare case with rupture of thymic cyst including mediastinal hemorrhage and hemothorax. A 68-year-old man was referred to our hospital for the treatment of right hemothorax. A chest roentgenogram following thoracentesis demonstrated a widened mediastinum. Chest computed tomograms revealed a large anterior mediastinal mass extending to the right pleural cavity and bilateral pleural effusion. Digital subtraction angiography showed a normal aorta and great vessels. A median stenotomy revealed a large encysted hematoma along the thymic cyst extending from the right anterior mediastinum into the right pleural cavity and ending with rupture. Pathological examination demonstrated that the largest thymic cyst was continued to the hematoma resulting from partial destruction of its epithelial lining. To our knowledge, only five cases including our's with ruptured thymic tumors were reported, and this is the first report of ruptured thymic cyst resulting in mediastinal hemorrhage and hemothorax.