Foregut mediastinal cysts: a narrative review.

Authors

S Michael Goertzen, Joshua M Boster, Patricia M de Groot, Stephen F Kralik, Neda Kalhor, Carlos A Jimenez

Published in

Mediastinum (Hong Kong, China). Volume 10. Pages 37. Epub Jun 29, 2026.

Abstract

Foregut mediastinal cysts are rare congenital anomalies arising from aberrant embryonic foregut development, with an estimated incidence of 1 in 42,000 to 1 in 100,000. These benign lesions, including bronchogenic, esophageal duplication, and neurenteric cysts, account for 12-20% of mediastinal masses. They may remain asymptomatic or cause respiratory, gastrointestinal, or neurological symptoms due to compression or complications like infection. This review aims to provide a comprehensive analysis of their embryogenesis, clinical presentation, diagnostic strategies, treatment options, and prognosis to guide clinical decision-making.
A review of the current literature was conducted with a focus on the embryologic origins, histopathologic classification, imaging characteristics, and treatment outcomes of foregut cysts. This narrative review addressed studies describing bronchogenic, esophageal duplication, and neurenteric cysts, with emphasis on diagnostic modalities and management strategies encompassing surgical resection and observation.
Bronchogenic cysts, the most common subtype (50-60%), typically occur near the carina, while esophageal duplication and neurenteric cysts are often posterior. Imaging, particularly computed tomography (CT) and magnetic resonance imaging (MRI), is critical for diagnosis, though histologic confirmation post-resection remains the gold standard. Symptomatic or complicated cysts warrant surgical resection, preferably via minimally invasive techniques like video-assisted thoracoscopic surgery (VATS) or robotic-assisted thoracoscopic surgery (RATS), which offer reduced morbidity. Complete resection yields excellent prognosis, with low recurrence rates, while incomplete resection increases recurrence risk.
Foregut mediastinal cysts require precise diagnosis and tailored management. Minimally invasive surgery is the cornerstone for symptomatic or ambiguous cases, ensuring favorable outcomes. Future research should focus on refining imaging techniques and standardizing management protocols.

PMID:
42763611
Bibliographic data and abstract were imported from PubMed on 20 Sep 2026.

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