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

Abstract

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.

Bronchogenic cyst of the stomach treated by surgical resection

“…Bronchogenic cysts of the stomach are rare and sometimes mimic gastrointestinal stromal tumours in terms of clinical symptoms and preoperative imaging . EUS‐guided fine‐needle aspiration can help in pre‐operative diagnosis.…”

“…Bronchogenic cysts of the stomach are rare and sometimes mimic gastrointestinal stromal tumours in terms of clinical symptoms and preoperative imaging. [7][8][9] EUS-guided fine-needle aspiration can help in pre-operative diagnosis. Interventions, such as surgical or endoscopic resection, is recommended in symptomatic cases or in case of diagnostic dilemma.…”

Carcinoid tumor arising in a thymic bronchogenic cyst associated with thymic follicular hyperplasia

“…Four had intratumoral calcification, but no specific distribution was noted. The attenuation of proteinaceous content in bronchogenic cysts is comparable to soft tissue and may disguise the cysts, making them appear solid on CT. 33 Helpful clues are internal homogeneity and smooth and thin mural enhancement. Magnetic resonance imaging (MRI) is helpful in this setting as the signal intensity of the cyst content is close to cerebrospinal fluid on T2-weighted images.…”

Gastric duplication (bronchogenic) cyst mimicking a gastrointestinal stromal tumour

“…The cyst wall shows contrast enhancement and calcification (9). The cyst can be seen as a solid mass due to mucus accumulation (3,9,10). In such cases, it is difficult to differentiate this lesion from other soft tissue masses.…”

“…Surgical resection is recommended in symptomatic patients (1,2,10). Treatment options include open or laparoscopic resection and endoscopic snare resection (2).…”