bronchogenic cysts are not uncommon in either children or adults . in children , they comprise approximately 6% of all mediastinal masses . their presentation can range from an asymptomatic incidental finding to sudden respiratory distress . video - assisted thoracoscopy was utilized to remove a bronchogenic cyst that was densely adherent to the adjacent esophagus in a child . the chest tube was removed on postoperative day 1 , and the patient was discharged on postoperative day 2 . an esophagogram obtained 2 weeks after surgery was normal , and the patient 's preoperative symptoms had not returned . bronchogenic cysts should be considered in the differential diagnoses for mediastinal masses at any age . given their benign nature . they may become symptomatic due to esophageal compression as they increase in size or from development of infection . we report the case of a 9-year - old female with a symptomatic bronchogenic cyst , undiagnosed since the age of 2 years , who underwent successful thoracoscopic excision . a 9-year - old girl was first seen at the age of 2 years for cough and fever in the emergency room . a chest x - ray was obtained at that time , which was interpreted as normal . nonetheless , the patient was diagnosed with pneumonia , given a prescription for antibiotics , and released . subsequent to this , she presented several more times each year with similar complaints and with identical posteroanterior ( pa ) chest x - ray findings , resulting in several hospital admissions . her examination revealed no abnormalities , and her laboratory work was within normal limits at the time of her presentation to the pediatric surgery service . repeat chest x - rays were obtained ( figure 1 ) as well as a computed tomography ( ct ) scan of the chest ( figure 2 ) . it revealed a well - circumscribed cyst in the right chest measuring approximately 3x4 cm directly adjacent to the esophagus in the midthoracic region . it was unilocular and homogenous and did not appear to communicate with the esophagus or any neural structures . given these findings , the diagnosis of either an esophageal duplication cyst or bronchogenic cyst was entertained . a thoracoscopic approach was utilized to evaluate and remove the mass ( figure 3 ) . the medial aspect of the cyst was intimately involved with the muscular wall of the esophagus for several centimeters . a harmonic scalpel was used to separate the cyst , which was filled with a white mucoid material , from the esophagus . a small portion of the cyst wall was left in place to avoid perforation of the esophagus . the chest tube drainage was negligible , and it was removed on postoperative day one . she was seen at follow - up 2 weeks after surgery where a normal barium esophagogram ( figure 4 ) was obtained , and her preoperative symptoms were completely resolved . bronchogenic cysts are embryological remnants that are isolated from the normal development of the foregut . on rare occasions they may be found incidentally on a radiographic study or once symptoms are produced as a result of compression or infection . if communication with the airways occurs , an air - fluid level is usually present . histologically , they are lined with ciliated columnar epithelium and can contain cartilage and bronchial glands . accepted treatment is excision because of concern about continued growth and subsequent compression of surrounding structures , the risk of infection , and the unlikely but reported possibility of malignant degeneration . bronchogenic cysts comprise approximately 6% of all mediastinal masses in children , while foregut cysts as a group account for 15% . traditionally , open thoracotomy has been the method by which these cysts have been removed . even with increasingly sophisticated radiographic and percutaneous techniques , an exact diagnosis is often uncertain , and the unequivocal diagnosis must be made surgically . thoracoscopy offers both a minimally invasive diagnostic modality and also a highly successful method of definitive therapy for patients with bronchogenic cysts . although many case reports exist regarding bronchogenic cysts and their minimally invasive treatments , reports of precious few series have been published regarding their thoracoscopic excision . in 1993 , hazelrigg published a series of seven bronchogenic cysts removed thoracoscopically with favorable results . martinod et al reported a series of 20 cases of bronchogenic cysts in adults , of which they successfully removed 13 thoracoscopically . their reasons for conversion were bleeding in 2 cases and dense adhesions to surrounding vital structures in 5 . in 5 cases , thoracoscopy was performed on 22 children , 15 of which were found to have bronchogeni ccysts . of these merry et al reported in their series of 8 foregut duplications 1 recurrence with incomplete excision 1 year after surgery . two other reports of recurrence have been reported , , but so have several reporting successful obliteration of the mucosal lining with good results . reported complications in these articles include the following : bronchial / tracheal laceration ( both repaired endoscopically ) , , recurrence , esophageal injury , pneumothorax , , vascular injury . bronchogenic cysts are not uncommon and , as this case illustrates , can be easily misdiagnosed . subtle findings , as on this patient 's chest x - ray taken at 2 years of age , are overlooked if one fails to consider cystic mediastinal masses in the differential diagnosis . we assert that thoracoscopy is a safe and effective method to deal with bronchogenic cysts and involves considerably less morbidity than thoracotomy does . as experience with thoracoscopy improves , so too will its acceptance as a superior alternative to thoracotomy in most cases of bronchogenic cysts .