Abstract
Thymolipomas are benign lesions in the anterior mediastinum that most commonly present in the first three decades of life. They often are asymptomatic and can be very large at time of diagnosis. After incidental detection of a thoracic mass on an abdominal ultrasound, an otherwise well 10 years old male was evaluated with further imaging, including a cardiac-gated magnetic resonance imaging (MRI) study. This demonstrated that the mass was intimate with but did not appear to invade the pericardium, likely originating from the thymus. Despite the large size, the patient underwent robotic resection of the mass and we include photographs illustrating the minimally invasive approach and highlighting critical structures. The patient tolerated the procedure well and recovered quickly. Final pathology was consistent with a giant thymolipoma. In summary, workup of giant thymolipomas is optimized with cardiac gated imaging. Despite their large size, these can be safely managed in a minimally invasive fashion in pediatric patients.