Almost half of patients with mediastinal cysts or tumours are asymptomatic. Lesions are often discovered incidentally on X-ray.
Local symptoms may result from compression or invasion of mediastinal structures and include cough, dysphagia, recurrent pulmonary infection, dyspnoea, pain and rarely haemoptysis. Most bronchial, gastric and gastroenteric cysts are asymptomatic although the latter can be life threatening because of gastric secretion leading to haemorrhage, peptic ulcer and perforation. Superior vena cava (SVC) syndrome, due to compression or invasion of the superior vena cava usually indicates the presence of malignancy but can be caused by benign fibrosing mediastinitis.
Myasthenia gravis is present in one third of patients with thymomas. Symptoms include fatigability affecting the proximal limb muscles, extraocular muscles, muscles of mastication, speech and facial expression. Respiratory difficulties may occur. Other associated conditions in 5-10% of cases are red cell aplasia with a severe anaemia, hypogammaglobulinaemia resulting in bacterial infections and diarrhoea, and pemphigus foliaceous producing skin blisters.
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