Media Files - media items stored on disk (keep this folder) Media Cache - is where sitecore caches image versions (eg rezised images)
You can delete the entire contents of the Media Cache folder. Sitecore will gradually recreate the image cache of images that are used on sites.
If you use version control of elements, you can use Version Manager and archive old versions. However, as you have a nearly identical size Master and Web database, I donβt think it will help you. The web database contains only one version of each item.
The last thing you would need to scan through the media library is to find items that have no links in LinkDatabase and delete them. First make sure you return everything.
http://trac.sitecore.net/VersionManager
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