Mediastinal teratoma often grows to a large size and becomes adherent to the surrounding cardiopulmonary structures. Although a mature mediastinal teratoma is histologically diagnosed as benign, the inflammatory adhesion around the tumour sometimes makes surgical management difficult and invasive. Moreover, perforation of the tumour into the pericardial sac causes cardiac tamponade, a rare but life-threatening complication. The mechanism of perforation into the adjacent structures remains controversial. We describe a case of mature mediastinal teratoma complicated by cardiac tamponade caused by pressure necrosis of a small cyst within tumour. A 9-year-old previously healthy Japanese girl was referred to us because of severe dyspnoea and chest pain, which had developed 4 months previously. On the day of admission, she complained of sudden worsening of symptoms.
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