Delayed presentation of esophageal perforation simulating paraesophageal hernia

Generally, benign lesions, which make up the majority of mediastinal tumors and cysts, are asymptomatic; however, they may produce clinical findings. We report on a patient with presumed silent esophageal perforation whose cl inical and radiologic assessment was suggestive of massive paraesophageal h iatus hernia. However, surgery revealed a paraesophageal cyst and histology was reported as acute organizing pleurisy. A reasonable, tentative, preope rative diagnosis for each mediastinal lesion can be frequently made by cons idering its location in the mediastinum, the age of the patient, the presen ce or absence of local or constitutional symptoms and signs, and the associ ation of a specific systemic disease state. However, the precise nature of a lesion in the mediastinum, as elsewhere, cannot be determined without his tologic examination of the tissue. To our knowledge, this unusual clinical case is not been reported in the literature.