We present a rare case with a presentation of symptomatic bronchogenic cyst mimicking an esophageal lesion in a patient with chronic cough. The patient later suffered from hematemesis. The CXR revealed a middle mediastinal mass with an air-fluid level. The majority of adult patients with bronchogenic cyst are asymptomatic. In this case, the cyst was inflammatory and compressed surrounding organs such as the esophagus and bronchus. At first, an attempt was made to use video-assisted thoracoscopy to remove the cystic lesion, but this failed. Finally, a right-side thoracotomy was used to excise the cystic lesion, due to its firm adhesion and inflammatory change. We review the related literature and discussed the clinical presentation and management.