CTICasesMediastinal Metastasis from Testicular Teratoma Mimicking Bronchogenic Cyst
[...]. Mediastinal Metastasis from Testicular Teratoma Mimicking Bronchogenic Cyst. CTICases. Published September 11, 2026. https://cticases.com/c/g4u2p
Imaging findings
The chest radiograph showed a convexity in the azygoesophageal recess, the classic location for a bronchogenic cyst, with a lateral view that added little. On CT the lesion measured a mean of about 9 Hounsfield units, low enough to look cystic, and a port was visible. The patient had undergone left orchiectomy earlier that year for teratoma, making this a metastatic deposit rather than a foregut duplication cyst.
Key takeaways
Location is seductive but not diagnostic. A low attenuation lesion in the azygoesophageal recess is classic for a bronchogenic cyst, yet germ cell tumors frequently have cystic components and low attenuation, so in a patient with a treated testicular primary the same appearance is a metastasis until proven otherwise. The decisive argument is behavior over time rather than attenuation: a bronchogenic cyst may slowly enlarge but it does not newly appear. Prior imaging and clinical context settle it, and here the port was the visible clue that history was missing. Bronchogenic cyst attenuation is also often higher than water, around 30 Hounsfield units or more because of mucoid content, and the mucus can calcify.
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