Primary Isolated Mediastinal Abscess Masquerading as Mediastinal Mass- A Needle did the Trick

Mediastinal abscess is an uncommon medical condition usually secondary to infection elsewhere. This study reports a case of a young male with fever, dry cough, reduced appetite and weight loss for one month presenting radiologically as a mediastinal mass. Flexible video-bronchoscopy with trans-tracheal needle aspiration revealed thick pus which was sterile on microscopy and culture. The patient was hospitalized and broad spectrum intravenous antibiotics were started. After few days, the patient developed worsening of symptoms. CT-guided percutaneous aspiration of abscess was done with immediate relief in compressive but persistence of constitutional symptoms. Anti-tubercular therapy was initiated and patient showed marked clinical improvement on follow-up visits.