IS Case 65: Bronchogenic Cyst

Salman Mirza, DO

Imaging Sciences URMC 2008
Publication Date: 2009-05-19

History

Patient is 61-year-old woman who reports chronic cough with change in nature of sputum over the past several weeks. Patient denies dysphagia or odynophagia. Patient does report some heartburn.

Diagnosis

Bronchogenic Cyst

Discussion

Bronchogenic cysts, while relatively rare, represent the most common cystic lesion of the mediastinum. In infants and small children, these cysts can be life threatening when they compress vital structures. Subcarinal cysts, in particular, can pose life-threatening airway compromise. In infants, initial presentation may be respiratory distress. More than one half of patients are asymptomatic. The cysts are usually found using antenatal sonography and routine chest radiography and during evaluations for GI or cardiac symptomatology. Bronchogenic cysts are the result of anomalous development of the ventral foregut; they are usually single but may be multiple. They have been found all along the tracheoesophageal course, in perihilar or intraparenchymal sites, with a predilection for the area around the carina. They have also been described in more remote locations, including the interatrial septum, neck, abdomen, and retroperitoneal space.

Conventional 2-view chest radiography and barium swallow are often sufficient to support a preoperative diagnosis. Additional clarification may be obtained using chest CT and MRI studies.

Surgical specimens of excised bronchogenic cysts show cystic lesions lined by respiratory epithelium. Occasionally, cysts may contain gastric mucosa or bronchial cartilage. Differentiation between congenital and acquired cysts may be difficult.

Cyst-related complications such as infection, rupture, bleeding, and compression are common. A risk of malignant degeneration is also noted. Other reported complications include airway-cyst fistula, ulceration, and hemorrhage. Arrhythmias and superior vena cava syndrome may also develop.

References

Webb WR, Higgins CB. Thoracic Imaging: Pulmonary and Cardiovascular Radiology. Lippincott, Williams & Wilkins, 2004:5-6, 288-289.