Patient: Description (time of onset, main symptoms, hospital visited, etc.): For the past three months, there has been tightness in breathing, mixed with chest tightness, and the thorax is symmetrical with the mediastinum in the middle of the chest as seen on CT. The trachea and lobar bronchus are open. The bronchial tracts of both lungs are in motion. There is no obvious abnormality in the morphology and no clear lesion in the lung field. Multiple small lymph nodes were seen in the mediastinum, and a circular watery density foci of about 12 mm in diameter were seen behind the vena cava, with a CT value of about 0 Hu on plain scan, and no enhancement was seen after enhancement. Heart. The morphology of large blood vessels. No abnormalities in size. No significant thickening of the pleura bilaterally. No significant fluid accumulation in both chambers and pericardium. Diagnosis: Mediastinal bronchial cysts are likely, and small mediastinal lymph nodes are shown. What kind of disease do you think this diagnosis is and what are the consequences? Bronchial cysts are often benign diseases caused by abnormal branching of the tracheobronchial tree during embryonic development. They can be solitary or multiple and can range in size from a few millimeters to a dozen or even timely centimeters. The typical x-ray presentation is an isolated well-defined round or ovoid shadow with uniform density. It is characterized by not communicating with the bronchi unless infected. Cysts can become infected and contain air or both fluid after communication with the outside world. Mediastinal bronchial cysts are mostly located near the bulge and are connected to one side of the bronchus by a tip. Symptoms can be produced by pressure from surrounding structures. Mediastinal cysts may compress the airways causing dyspnea, croup or persistent cough, which is significantly worse with exercise. In some adults, mediastinal bronchial cysts can grow to be very large and asymptomatic. Small and asymptomatic cysts can be left untreated, while large, tense cysts with recurrent infections can be considered for surgical removal. Of course, there can be other types of intra-mediastinal cysts, and the details will depend on your imaging data. Please upload your CT film. Patient: Yes, thank you. I will upload the pictures for you. The film is rather vague, you can also see the posterior round-like shadow at the place where the left unnamed meridian of the mediastinum converges into the superior vena cava, no clear CT value markings are seen, the report suggests that the CT value is watery density, no enhancement, mediastinal cyst may exist, this location is a certain distance from the esophagus, pericardium, thymus, adjacent to the trachea, the possibility of bronchogenic cyst is high. Since your cyst is relatively small and there is no obvious pressure narrowing of the trachea, the symptoms of shortness of breath and chest tightness may not be related to this mass. In addition, pulmonary function suggests abnormal small airway function and obstructive row ventilation dysfunction, so the cause of symptoms should also be considered firstly obstructive lung diseases such as chronic bronchial disease or asthma, which should also refer to medical history, physical examination results and relevant auxiliary examinations. Mediastinal lesions can be observed in the absence of any symptoms, but if they grow or change in nature within a short period of time, suspicion of malignancy and symptoms of compression such as coughing can be considered for surgery. Patient: Sincerely thank you!