Fortunately, much has changed. Thoracotomy for benign lesions, which accounted for ≥ 60% of operations in the 1960s and 1970s, especially in endemic fungal regions, is now rare. In addition, nonresective thoracotomy for lung cancer currently occurs in < 5% of cases. There are two reasons for this improvement. First and foremost are the dramatic advances in imaging that have occurred in the last 2 decades and that continue to evolve exponentially. Second, procedures such as needle biopsy and thoracoscopy have markedly reduced the need for thoracotomy. Although still occasionally required and associated with low risk, open surgery, including minimal thoracotomy, that yields a benign diagnosis invariably induces this thoracic surgeon to retrace the pathway that led to the operating room to determine whether other options might have been preferable. What these musings have to do with mediastinal cysts is that, like the pseudotumor, these cysts are benign, can be diagnosed with certainty by imaging, and are mostly asymptomatic. If doubt remains or if symptoms are thought to be related to the cyst, procedures other than open operation, some nonsurgical, may be applicable.