Month ago I treated a 1 year old boy with a huge cervicomediastinal lymphangioma by aspiration the clear lymphatic fluid with subsequent injection into the cavity of Bleomycin and Triamcinolon. There were 4 bigger and many smaller cysts with propagation to the anterior mediastinum. Three days before the second stage the sclerosation therapy the outer cysts augmented and became harder without pain sensation. The sonography demonstrated these cysts with more tightly content unlike other (some of them no treated) cysts. There is no evidence of trauma or infection.   

At the second attempt I aspirated by punction nearly 90 ml transparent homogenous fluid with dark red coloration. The US guidance indicated presence of many noncommunicating cysts. After application of 8 ml diluted Bleomycin I interrupted the manipulation by my own decision.

Now I intend to perform a first stage cervicotomy, and then a second stage thoracotomy in order to achieve radical extirpation of the lymphatic bundle. I have experience with cervicothoracic lymphangioma cases, executing in some of them one-stage cervicosternotomy. But this is a traumatic approach. Would you suggest another tactic?