Bronchogenic cyst presenting as mediastinal mass with pleural effusion

Abstract

Mediastinal bronchogenic cysts are usually identified on computed tomography (CT) as well-defined masses of variable density that may contain rim calcifications. Pleural effusion has never been described in association with these cysts.We report two cases of bronchogenic cysts with unusual presentation because of an association with a pleural effusion not explained by pulmonary infection. The patients were studied with CT scan (n=2) and magnetic resonance imaging (MRI) of the chest (n=1).In the first case, the pleural effusion directed diagnosis towards lung tumour; and the diagnosis of bronchogenic cyst was made on thoracotomy. In the second case, bronchogenic cyst was suspected on MRI findings. Inflammatory reaction was also suspected on the CT scan, which showed enhancement of the cyst edge.In both cases, surgical excision of the cyst was difficult because of pericystic adhesions to adjacent organs. Therefore, solely on the finding of a pleural effusion, pericystic inflammation had to be suspected. Eur Respir J., 1995Respir J., ., 8, 2185Respir J., -2187 Bronchogenic cysts are congenital abnormalities resulting from embryological budding of the bronchial tree; they often arise near the carina [1][2][3]. Mediastinal bronchogenic cysts are frequently detected incidentally, on routine chest radiographs. They manifest as smooth and well-circumscribed masses near the carina [2,3].We describe two cases of bronchogenic cyst that appeared as mediastinal mass with pleural effusion, without pulmonary infection. To our knowledge, this radiological manifestation, in association with bronchogenic cyst, has not previously been reported. Case reports Case 1A 49 year old man presented with a one month history of dysphagia. Chest radiography revealed right mediastinal mass and ipsilateral pleural effusion. Oesophagoscopy revealed a marked extrinsic compression of the oesophagus. Fibreoptic bronchoscopy showed an infiltration of the mucosa of the right intermediate bronchus.Biopsies were negative.Chest computed tomography (CT) scans showed a mediastinal tumoral mass with tissular density (35 Hounsfield units (HU)) and a right pleural effusion ( fig. la and b). CT guided needle biopsies were negative. The diagnosis of necrotic mediastinal malignancy with pleural effusion was suspected. Fig. 1. -Case 1. a) Computed tomography (CT) scan 10 mm thick slice, medistinal windows, shows the mass behind and under the carina, associated with a right pleural effusion. b) Lower level; the mass does not enhance after contrast media injection. Enhancement of its right edge is probably related to inflammatory mediastinal pleura or to a lung collapse around the mass. Right pleural effusion is apparent.

Bronchogenic cysts: clinicopathological presentation and treatment

“…MATZINGER et al [21] reported a case of intrapulmonary bronchogenic cyst in a 16 year old girl presenting with pneumothorax. Other reported complications are pleural effusion [22,23], arrhythmias [24], stenosis of the pulmonary artery [25], unilateral ventilation-perfusion defect [26], pericardial and cardiac tamponade [27], carcinomatous [28] or sarcomatous transformation [29], and giant tension bronchogenic cyst [30]. Intrapulmonary bronchogenic cysts generally present as one of three different patterns on the chest radiograph.…”

Epigastric Pain and Pleural Effusion in a 12-Year-Old

“…4 Bronchogenic cysts do not commonly cause pleural effusions. Three previous case reports describe pleural effusions associated with bronchogenic cysts in adult patients [5][6][7] but no cases were in children. In addition, the pleural effusion in these cases was clear fluid rather than hemorrhagic.…”

Bronchogenic CYST: A Rare Case Report

“…Percutaneous or transbronchial aspirations of the content of the cyst has also been used to treat bronchogenic cyst for high risk surgical patient [11]. "In all symptomatic patients, according to Mawatari et al the treatment should depend on the size and location of the cyst and their adherence to the surrounding structures" [12]. A small cyst, carinal in location and free from surrounding structures could be operated when diagnosed.…”