Bronchogenic cysts: clinicopathological presentation and treatment

Aktoğu, Serir; Yuncu, Gökhan; Halilçolar, Hüseyin; Ermete, Sülün; Buduneli, Teoman

doi:10.1183/09031936.96.09102017

Cited by 147 publications

(155 citation statements)

References 36 publications

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“…Th is is explained by the fact that bronchogenic cysts can contain proteinaceous fl uid resulting in high HU seen on a CT scan [5,6]. Our fi ndings are confi rmed by previous studies that demonstrating that bronchogenic cysts frequently have high HU resembling those of soft-tissue or solid tumors [5,10]. On the other hand, McAdams et al found cysts with a radiographic density higher than 20 HU in 25 out of 62 patients [11].…”

Section: Discussionsupporting

confidence: 84%

Bronchogenic cysts in adults: frequently mistaken for a solid mass on computed tomography

Vos

Hartemink

Golding

et al. 2011

Wien Klin Wochenschr

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Schlussfolgerung: Bronchogene Zysten werden häufi g fälschlich in der CT als solider Tumor diagnostiziert. Wenn die CT inkonklusiv ist, kann mittels MRI oder Ultraschall (EUS) die Diff erentialdiagnose getroff en werden. Summary. Background:Bronchogenic cysts are congenital malformations and are often detected in asymptomatic patients as an incidental fi nding. Growth can cause compression of airways and vessels, resulting in clinical symptoms and possible complications. On computed tomography (CT) scans, bronchogenic cysts frequently have the appearance of a solid tumor. We describe diagnostic strategy and management for patients with bronchogenic cysts.Methods: Retrospective case study of 11 adults diagnosed with a bronchogenic cyst. Th e CT scan of all patients was revised and localization, size, Hounsfi eld Units (HU), and appearance (cystic or solid) of the lesions were reported. Lesions were arbitrarily considered cystic or solid when the radiographic density was below or above 20 HU, respectively.Results: Eleven adults with a bronchogenic cyst were followed for at least 2 years after diagnosis. Eight of 11 detected lesions were judged as a solid lesion, based on the radiographic density (in HU) on CT images. Nine of 11 patients were treated by surgical resection. Two asymptomatic patients were not operated and remained asymptomatic without enlargement of the cysts during 2 years follow-up. Complications of resection were postoperative bleeding (n = 1), recurrent pneumothorax (n = 1), and recurrence of the cyst (n = 1). No mortality was observed.Conclusion: Bronchogenic cysts are frequently mistaken for a solid mass on CT scans. Further diff erentiation can be made by MRI or EUS when CT is inconclusive.

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Section: Discussionsupporting

confidence: 84%

Bronchogenic cysts in adults: frequently mistaken for a solid mass on computed tomography

Vos

Hartemink

Golding

et al. 2011

Wien Klin Wochenschr

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“…It was reported in several studies that greater intra-operative and post-operative complications and difficulty occur in those patients who were symptomatic before the operation, compared with asymptomatic patients. 2,3 In the study by Patel et al 2 and in other major studies, it is documented that it is common for asymptomatic patients to develop symptoms. It is therefore recommended that even asymptomatic cysts are removed to limit operative morbidity.…”

Section: Treatmentmentioning

confidence: 99%

“…Other symptoms include purulent sputum, dyspnoea, fever, anorexia and weight loss, haemoptysis and dysphagia. 2,3 Other serious reported complications include extrinsic pulmonary artery stenosis, superior vena caval obstruction, pericardial tamponade, arrhythmias, pulmonary oedema, pneumothorax, thrombosis and air embolism. 2 Carcinomatous and sarcomatous transformation have also been reported.…”

Section: Clinical Presentationmentioning

confidence: 99%

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An unusual cause of chest pain in a young man: bronchogenic cysts and their cardiac manifestations

Magro¹,

Micallef²,

Falzon³

et al. 2010

JRCPE

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A 24-year-old previously healthy man was admitted to our casualty department with a two-day history of worsening central retrosternal chest pain, diaphoresis and dyspnoea. An electrocardiogram showed ischaemic changes ( Figure 1) and a subsequent echocardiogram showed a mass, posterior to the right atrium. The mass, which was not arising from the heart, was impinging on the oesophagus (Figure 2) and right pulmonary arteries. A computed tomography (CT) scan of the thorax revealed a homogeneous, hypodense mass, about 6 cm in diameter, behind the right atrium, and excluded the possibility of an aortic aneurysm (Figure 3). The patient was treated symptomatically with opiate analgesia due to the severity of the pain. A causal connection between the symptoms and clinical findings was assumed and surgery was carried out a few days after admission. Histological examination of the mass showed fragments of connective tissue covered by pseudostratified and squamous epithelium. The presence of ciliated epithelium in some places made bronchogenic cyst the most likely diagnosis. The patient has remained symptom-free to the present day, one year after surgery.The mechanisms underlying the pathophysiology of the ischaemic changes in our patient are not clear. Given that he has remained free of symptoms post-operatively, the most likely cause of his symptoms was impingement of the cyst on the coronary vessels producing the ischaemic changes. In our literature review we draw attention to the association between cardiac ischaemia and anginal symptoms and the presence of a bronchogenic cyst. Infection is thought to have played a part in the cyst becoming symptomatic, possibly due to an acute increase in fluid content, although the fluid cultures remained sterile.Cysts of the mediastinum that are benign masses constitute a small but important diagnostic group, representing 12-18% of all primary mediastinal tumours. The classification of mediastinal cysts is based on their aetiology, encompassing bronchogenic, oesophageal duplication cysts of foregut origin, mesothelial-derived pericardial/pleural cysts and thymic cysts. Bronchogenic cysts are classified as foregut cysts, together with oesophageal cysts, and occur more frequently than oesophageal cysts.1 The first reported case of a bronchogenic cyst was by Meyer in 1859. 2 An unusual cause of chest pain in a young man: bronchogenic cysts and their cardiac manifestations ABSTRACT We report a case of a 24-year-old man who presented with chest pain and electrocardiographic evidence of myocardial ischaemia. An abnormal structure located behind the heart on the urgent transthoracic echocardiogram and a computed tomography scan of the mediastinum led to prompt surgery with eventual resection of the lesion. The histology revealed fragments of connective tissue covered by squamous epithelium and ciliated epithelium, consistent with a bronchogenic cyst. The case study is accompanied by a literature review of the pathogenesis, diagnosis and management of bronchogenic cysts and their associati...

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“…Mediastinal bronchogenic cyst causing unilateral obstructive emphysema in infants is a rare presentation and only a few cases are reported in the literature [5,[7][8][9][10]. Mediastinal bronchogenic cysts can produce lobar or pulmonary emphysema by obstructing the lobar or main bronchus.…”

Section: Introductionmentioning

confidence: 99%

Unilateral Obstructive Emphysema in Infancy due to Mediastinal Bronchogenic Cyst-Diagnostic Challenge and Management

Vimala

Sathya

Lionel

et al. 2015

JCDR

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A one and half month old infant was brought to the paediatric emergency department in June 2014 with complaints of fever and fast breathing of one week duration. He was evaluated in a local hospital and was suspected to have pneumothorax on chest radiograph and hence referred to our institution for further management of pneumothorax.He was the first child to non-consanguineous parents born by normal vaginal delivery at term. His neonatal period was uneventful and he was feeding well and active till he developed the above symptoms. At admission to emergency department, he had tachypnoea and severe respiratory distress. In spite of severe respiratory distress he was alert. His respiratory system examination revealed decreased air entry on the left side. No other dysmorphic features were noticed. In the emergency department chest radiograph was done. As the clinicians initially suspected pneumothorax, an emergency needle thoracostomy was done by inserting the needle in the left second intercostal space; minimal air bubbling was noticed in the underwater seal. He was started on high flow oxygen and admitted to paediatric ICU.However, his symptoms were not improving and an intercostal drain was placed as an emergency measure. The chest radiograph was reviewed and a differential diagnosis of congenital lobar emphysema was also considered as there was hyperinflation of the left lung with paucity of vessels and the mediastinum was shifted to the right [Table/ Fig-1]. CT thorax was done to confirm the diagnosis. Limited MRI sections were also done for better characterisation of the mediastinum. Imaging revealed a well-defined oval shaped lesion located just posterior to the left main bronchus, left lateral to thoracic oesophagus and just inferomedial to distal aortic arch [Table /Fig-2a,b &3a-c]. The lesion was compressing the left main bronchus and was causing obstructive emphysema in the form of hyperinflated left upper and lower lobes with normal vascular divisions which are widely separated within the overinflated lung [Table /Fig-2b,3c]. Small pneumothorax was also noted. There was herniation of left lung into the right hemithorax with mediastinal shift to the right and associated compressive atelectasis of right ABSTRACTBronchogenic cysts are the most common cystic mediastinal lesion in children. Bronchogenic cyst causing unilateral obstructive emphysema is a rare presentation. We report the case of a one and half month old infant who presented with respiratory distress which was initially suspected as left pneumothorax on frontal chest radiograph but was later found to be due to hyperinflated left lung and hence the possibility of congenital lobar emphysema was considered. CT thorax and limited MRI sections revealed a cystic lesion in mediastinum causing obstructive emphysema and mediastinal displacement. He underwent an emergency thoracotomy and excision of the cyst via an extrapleural approach. Post operatively, rapid improvement of the infant was noticed both clinically as well as radiologically. Cross section...

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Bronchogenic cysts: clinicopathological presentation and treatment

Cited by 147 publications

References 36 publications

Bronchogenic cysts in adults: frequently mistaken for a solid mass on computed tomography

Bronchogenic cysts in adults: frequently mistaken for a solid mass on computed tomography

An unusual cause of chest pain in a young man: bronchogenic cysts and their cardiac manifestations

Unilateral Obstructive Emphysema in Infancy due to Mediastinal Bronchogenic Cyst-Diagnostic Challenge and Management

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