Marsupialisation of Giant Bronchogenic Cyst through Right Anterior Minithoracotomy: A Case Report

Bronchogenic cysts are common mediastinal lesions; however, intrapericardial occurrence is exceedingly rare. The authors report the case of a 50-year-old female who presented with persistent cough and right shoulder pain of three months’ duration. The patient is a known case of systemic hypertension and diabetic type 2 for 5 years and patient was taking medication for the same for 5 years, bronchial asthma, or pulmonary tuberculosis. Clinical examination was unremarkable. Contrast-Enhanced Computed Tomography (CECT) of the chest revealed a large, well-defined intrapericardial cyst causing significant compression of the Left Atrium (LA) and displacement of adjacent mediastinal structures without evidence of invasion. Given the symptomatic presentation and anatomical complexity, surgical management was undertaken. The patient underwent marsupialisation through a minimally invasive right anterior mini-thoracotomy. Intraoperatively, the cyst was found to be densely adherent to surrounding vital structures, including the pulmonary artery and LA, precluding safe complete excision. Approximately, 200 mL of thick mucinous fluid was aspirated, and the cyst wall was opened, everted, and plicated. The postoperative course was uneventful. The patient was extubated early, remained haemodynamically stable, and was discharged on Postoperative Day (POD) 4. Histopathological examination confirmed the diagnosis of a bronchogenic cyst. At the six-month follow-up, the patient remained asymptomatic, with no evidence of recurrence. The present case highlights marsupialisation as a safe and effective alternative in selected complex cases where complete excision carries significant risk.