Ruptured intrathoracic cyst during induction of anaesthesia: Anaesthetic challenges

Abstract

Congenital benign cysts are among the rare types of mediastinal masses. When symptomatic, complete surgical excision through thoracotomy is the definitive treatment. Rarely they may present with symptoms due to complications like rupture. However, rupture following the induction of general anaesthesia poses unique challenges for anaesthesiologist. We report our experience of a rare variant of intraparenchymal cyst (lung), which was subsequently found to be a bronchogenic cyst.

Considerations to Prevent Intraoperative Fluid Spillage Into the Airway From a Bronchogenic Cyst During Anesthesia: A Case Report

“…There are case reports describing bronchogenic cyst rupture and spillage of contents immediately after anesthesia induction, [3][4][5] but the pathophysiology and possible preventive measures are not clearly described. Our patient was examined in the preanesthesia clinic in a sitting position.…”

“…She was induced in a sitting position and on turning her supine for intubation, profuse, odorless, creamy, watery discharge was seen emerging from her oral and nasal cavities. 3 They described this event as a case of cyst rupture on induction of anesthesia. But, given the similarity of the presentation with our case, it is likely that turning the patient supine led to the spillage of contents through the existing communication rather than from rupture of the cyst.…”

“…A similar case was reported in a 14-year-old girl who was unable to lie supine and underwent a large bronchogenic cyst excision. 3 She used to sleep either in a prone or sitting position and did not tolerate supine positioning during anesthesia induction similar to our patient. She was induced in a sitting position and on turning her supine for intubation, profuse, odorless, creamy, watery discharge was seen emerging from her oral and nasal cavities.…”

“…1 A few instances of cyst rupture and spillage into the airway immediately after anesthesia induction are reported. [3][4][5] Little is known about the mechanism and conceivable ways to prevent this serious complication. We propose that position-dependent spillage of the cyst contents, but not rupture, may be the cause of tracheobronchial tree contamination.…”