Dyspnea after a greasy meal

A healthy 72-year-old man presented with dyspnea and dysphagia after saturated fat meals. The investigation showed a mediastinal mass causing compression of the trachea and main carina. Endobronchial ultrasound guided fine needle-aspiration revealed a milky fluid with an high concentration of triglycerides and chylomicra. The diagnosis of a thoracic duct cyst was made. Clinical stability was achieved through a conservative treatment since the patient refused other invasive therapeutic procedures.