Thymomas most commonly arise in the anterior mediastinum, whereas ectopic thymomas occurring outside the normal thymic bed are rare. Lesions arising in the cardiophrenic angle can pose a diagnostic challenge, as they may mimic other mediastinal cystic lesions on imaging. We report the case of a 43-year-old male who was incidentally found to have a well-defined lesion in the right cardiophrenic angle on contrast-enhanced computed tomography. The mass appeared as a heterogeneously enhancing solid-cystic lesion closely abutting the pericardium, raising suspicion for a cystic mediastinal lesion. The patient underwent robotic-assisted thoracoscopic excision of the mass. Intraoperatively, the lesion was well encapsulated and separable from surrounding structures. Complete excision was achieved without the need for pericardial resection. Histopathological examination confirmed the diagnosis of a thymoma. This case highlights the diagnostic challenges associated with unusual mediastinal masses and demonstrates the feasibility and effectiveness of robotic-assisted minimally invasive resection.

Extrinsic compression of the pulmonary artery by a mediastinal mass is an exceedingly rare cause of pulmonary stenosis. We report the case of a 22-year-old man with no relevant medical history who, during a pre-surgical evaluation, presented with a three-month history of exertional dyspnoea. Echocardiography demonstrated supravalvular pulmonary stenosis, and chest computed tomography revealed a giant mediastinal mass encasing the great vessels and causing collapse of the left pulmonary artery branch. Mediastinal biopsy and immunohistochemical analysis were consistent with a primary mediastinal germ cell tumour of seminomatous morphology, accompanied by serum alpha-fetoprotein elevation, leading to its classification as a high-risk extragonadal germ cell tumour. This case highlights the importance of multimodal imaging in the differential diagnosis of mediastinal masses with compressive cardiac involvement, as well as the value of histopathological correlation and tumour marker assessment in guiding prognosis and multidisciplinary management.

Purpureocillium lilacinum (P. lilacinum) is a rare opportunistic mold that predominantly affects immunocompromised hosts and exhibits intrinsic resistance to several conventional antifungal agents. Pulmonary infection is uncommon, and only a limited number of cases have been reported in patients with autoimmune connective tissue diseases receiving immunosuppressive therapy. We report a 37-year-old male hospital social worker with anti-Jo-1-positive myositis-associated interstitial lung disease receiving corticosteroids and mycophenolate mofetil who presented with hemoptysis and dyspnea. Computed tomography of the thorax demonstrated bilateral ground-glass opacities, multilobar consolidation, tree-in-bud nodularity, and mediastinal lymphadenopathy. Bronchoalveolar lavage fungal culture yielded P. lilacinum, with species identification confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Because second-generation triazoles were unavailable at the time of diagnosis, treatment was initiated with oral itraconazole (200 mg twice daily) together with temporary cessation of immunosuppressive therapy. The patient experienced rapid clinical improvement, with resolution of the acute pulmonary infiltrates on follow-up computed tomography after three months and a negative follow-up sputum fungal culture after six months of therapy. Immunosuppressive treatment was subsequently reintroduced without recurrence of infection or progression of interstitial lung disease during follow-up. This case highlights the diagnostic challenge of probable pulmonary P. lilacinum infection in immunosuppressed patients with myositis-associated interstitial lung disease. It demonstrates a favorable clinical course during prolonged oral itraconazole therapy when preferred antifungal agents were unavailable. However, treatment outcomes should be interpreted with caution, as this is a single case, and concomitant antibacterial therapy, along with temporary modification of immunosuppressive therapy, may also have contributed to recovery.

Congenital pulmonary airway malformation (CPAM) is a rare developmental anomaly of the lung that can present with a wide spectrum of clinical manifestations, ranging from asymptomatic incidental findings to severe respiratory compromise during infancy. We present the case of a one-year-old male infant with a giant multicystic pulmonary lesion involving the right upper and middle lobes, causing significant mediastinal shift and respiratory symptoms. The patient presented with recurrent episodes of lower respiratory tract infection, persistent cough, and progressive shortness of breath. Clinical examination revealed reduced air entry over the right upper and middle lung fields. Chest imaging demonstrated a large multicystic lesion almost completely replacing the right upper and middle lobes. CT of the chest revealed a purely multicystic mass lesion without a visible solid component, abnormal vasculature, or communication with the bronchial system. The lesion produced a significant mass effect with a contralateral mediastinal shift. Based on the clinical and radiological findings, CPAM was considered the most likely diagnosis. The patient underwent surgical resection with right upper and middle lobectomy. Histopathological examination confirmed the diagnosis of CPAM. The postoperative course was uncomplicated with resolution of respiratory symptoms and satisfactory clinical recovery during follow-up. This case highlights the importance of considering CPAM in infants presenting with recurrent respiratory symptoms and complex cystic lung lesions. Large lesions may remain undiagnosed until infancy and can produce significant anatomical distortion through compression of adjacent lung tissue and mediastinal displacement. Detailed radiological assessment is essential for characterization of the lesion, exclusion of vascular anomalies, and operative planning. Early recognition and appropriate surgical management of symptomatic CPAM can provide excellent outcomes and prevent potential complications associated with persistent abnormal lung tissue.

Multiple giant mediastinal liposarcomas are rare and associated with a high propensity for recurrence. Surgical management is extremely challenging and carries substantial risks. Here we report the case of a 40-year-old male patient who underwent multiple surgical resections for mediastinal liposarcoma. In April 2016, the patient presented with an intrathoracic mass and underwent right thoracotomy at our institution; postoperative histopathology confirmed a myxoid liposarcoma. Over the following decade, the patient received six cycles of chemotherapy and two cycles of anlotinib. In 2025, due to progressive dyspnea and chest tightness, chest computed tomography revealed multiple giant masses in the mediastinum and pleural cavity. In December 2025, the patient underwent resection of mediastinal tumors via a left seventh intercostal thoracotomy, followed by another resection via a right seventh intercostal thoracotomy in April 2026. Postoperative recovery was uneventful.

Background Esophageal duplication cysts (EDCs) are rare congenital foregut malformations, accounting for only 0.5 to 2.5% of all esophageal masses. Although typically diagnosed during childhood, adult presentations are uncommon and frequently characterized by asymptomatic progression or non-specific clinical features. We report the case of a 58-year-old male presenting with atypical chest pain and anxiety. Multimodal imaging (CT and MRI) revealed a massive posterior mediastinal mass measuring 12 × 11 cm that exerted significant mechanical compression on the left atrium. The patient underwent a successful right posterolateral thoracotomy for surgical resection. Histopathological examination confirmed the diagnosis of an esophageal duplication cyst. The postoperative course was uneventful, with complete resolution of symptoms. Giant EDCs should be considered in the differential diagnosis of mediastinal masses in adults, even when presenting with atypical cardiovascular symptoms. Surgical resection remains the definitive treatment of choice to prevent long-term complications and establish a formal histological diagnosis.

Spindle cell lipoma (SCL) is a rare benign lipomatous tumor that typically arises in the posterior neck, upper back, and shoulders. SCL of the retropharyngeal space is exceptionally rare, with only a few cases reported in the literature. We present a case of a 32-year-old man with a 3-year history of progressive neck swelling, dysphagia, and dysphonia. The patient initially attributed the neck swelling to his heavier body habitus. After weight loss failed to resolve the mass, worsening voice quality and cosmetic concerns prompted him to seek medical attention. Computed tomography revealed a large heterogeneous mass measuring 21 cm, extending from the oropharynx to the superior mediastinum and occupying the entire retropharyngeal space. Physical examination demonstrated a diffuse, bilateral neck mass that was soft, elastic, and non-tender, with intact cranial nerve function. Transcervical en bloc excision with finger dissection was performed in collaboration with a thoracic surgeon (total operative time: 276 minutes). Histopathological examination confirmed spindle cell lipoma, characterized by bland spindle cells, mature adipocytes, and ropey collagen fibers. Immunohistochemical staining showed positivity for CD34 and S100 and negativity for desmin and MDM2, confirming the benign diagnosis. The patient became symptom-free immediately after surgery, with the most notable improvement being resolution of breathing difficulty. At 22 months of follow-up, there was no evidence of recurrence on clinical examination and contrast-enhanced computed tomography. This is the fifth reported case of retropharyngeal SCL in the English literature and the largest by size. Despite the extensive dimensions and proximity to critical neurovascular structures, simple transcervical excision with finger dissection proved fully effective. Clinicians should be aware of this rare entity and its distinction from malignant lesions such as liposarcoma to avoid overtreatment.

A woman in her early 20s at 30 weeks of gestation presented with elevated blood pressure, transaminitis, progressive dyspnoea, orthopnoea, exertional chest pain and peripheral oedema, raising concern for preeclampsia-associated cardiopulmonary disease or peripartum cardiomyopathy. Transthoracic echocardiography showed preserved left ventricular systolic function, normal left-sided filling pressures, right ventricular dilatation and an estimated right atrial pressure of 15 mmHg; N-terminal pro-brain natriuretic peptide was 57 pg/mL. Cross-sectional imaging revealed a large multi-cystic anterior mediastinal mass occupying the left hemithorax, displacing the heart and abutting/compressing major cardiopulmonary structures. Labour was induced at 34 weeks after clinical stabilisation. Three months postpartum, the patient re-presented with worsening dyspnoea and haemoptysis and underwent complete surgical resection. Pathology confirmed mature cystic teratoma and cardiopulmonary symptoms resolved after resection.