The presentation of the bronchogenic cyst is variable making preoperative diagnosis difficult. The majority are either asymptomatic or discovered incidentally. The most common presenting symptoms are cough, fever and dyspnoea. We discuss the case of a large bronchogenic cyst in the posterior mediastinum mimicking ischaemic cardiac pain in a patient with known heart disease. This case demonstrates the need for detailed investigations prior to the treatment of an assumed acute coronary syndrome as a bronchogenic cyst may be the rare cause of such symptoms.
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