Bronchogenic cyst: Difference between revisions
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[[Bronchogenic cyst ultrasound|Ultrasound]] | [[Bronchogenic cyst ultrasound|Ultrasound]] | ||
*Bronchogenic cyst has varied appearance, endoscopic ultrasound is a valuable option for diagnosis and surveillance. | *Bronchogenic cyst has varied appearance, endoscopic ultrasound is a valuable option for diagnosis and surveillance. Ultrasonography shows a hyperechoic fluid filled solid mass.<ref name="pmid19015445">{{cite journal| author=Teissier N, Elmaleh-Bergès M, Ferkdadji L, François M, Van den Abbeele T| title=Cervical bronchogenic cysts: usual and unusual clinical presentations. | journal=Arch Otolaryngol Head Neck Surg | year= 2008 | volume= 134 | issue= 11 | pages= 1165-9 | pmid=19015445 | doi=10.1001/archotol.134.11.1165 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19015445 }} </ref><ref name="pmid26986156">{{cite journal| author=Han C, Lin R, Yu J, Zhang Q, Zhang Y, Liu J | display-authors=etal| title=A Case Report of Esophageal Bronchogenic Cyst and Review of the Literature With an Emphasis on Endoscopic Ultrasonography Appearance. | journal=Medicine (Baltimore) | year= 2016 | volume= 95 | issue= 11 | pages= e3111 | pmid=26986156 | doi=10.1097/MD.0000000000003111 | pmc=4839937 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26986156 }} </ref> | ||
[[Bronchogenic cyst other imaging findings|Other Imaging Findings]] | [[Bronchogenic cyst other imaging findings|Other Imaging Findings]] | ||
Revision as of 00:00, 8 July 2020
| Bronchogenic cyst | |
| DiseasesDB | 1707 |
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| MeSH | D009404 |
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Bronchogenic cyst Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Bronchogenic cyst On the Web |
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American Roentgen Ray Society Images of Bronchogenic cyst |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor: Cafer Zorkun, M.D., Ph.D. [2]
Synonyms and keywords: Bronchial cyst
Overview
Bronchogenic cyst is a benign congenital malformation of the tracheobronchial tree derived from the ventral aspect of the foregut. It is most frequently occurs in the middle mediastinum, in the early stages of gestation or in the lungs, at the later stages of gestation. Atypical locations may be explained by its embryologic origin. Radiologic findings are useful to differentiate bronchogenic cysts from other cysts but may they not always confirm the diagnosis
Historical Perspective
There is currently no information on the historical perspective of bronchogenic cyst.
Classification
Bronchogenic cyst can be classified based on location as follows[1][2]
1. Pulmonary
A. Plural
i. Visceral
ii. Parietal
i. Paratracheal
ii. Carinal
iii. Hilar
2. Extra-pulmonary
A. Cranial
C. Mediastinal
ii. Cardiac
D. Abdominal
ii. Retroperitoneal
E. Perianal
| Bronchogenic cyst | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Pulmonary | Extra-pulmonary | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Plural | Tracheobronchial tree | Cranial | Cervical | Mediastinal | Abdominal | Perianal | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Visceral | Parietal | Paratracheal | Carinal | Hilar | esophageal | Cardiac | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Intraperitoneal | Retroperitoneal | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Diphragmatic | Gastric | Hepatic | Spinal | Adrenal | Pancreatic | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Paraspinal | Intraspinal | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pathophysiology
It is thought that bronchogenic cyst arises from abnormal budding of the ventral [6] portion of the primitive foregut,[1][2][3]destined to become the tracheobronchial tree. [7] At such, it is always found in relation to the trachea or esophagus. [8] If the connection is maintained, the cyst becomes intrapulmonary. [1][9] This abnormally is thought to occur between days 26 - 40 of gestation. [7]
Gross pathology
Bronchogenic cyst appear as single or multiple smooth spherical pink masses which may be unlobulated or lobulated. [7][1] The lobules could be of various sizes, communicating or noncommunicating. The wall is relatively thin, although there may be thicker portions and is lined by clilated columnar epithelium which secretes a thick white to dirty brown mucoid material.[1] Occassionally, secretions could be hemorrhagic or pneumatic.[2]
Histopathology
Bronchogenic cysts are usually lined by ciliated columnar epithelium of respiratory type, leading to distention as a result of secretions produced within the cavity. Cyst wall may be composed of cartilage, smooth muscle, fibrous tissue and mucous glands. [7] [1] [10] [3]
Causes
The cause of bronchogenic cysts is undetermined.
Differentiating Bronchogenic cyst from other Diseases
Cervical bronchogenic cysts are difficult to differentiate from other cystic cervical masses clinically because their location, radiologic findings, and evolution can imitate those of any other cervical mass.[3] Diagnostic confirmation is based on histologic findings which shows ciliated columnar epithelium of respiratory type[3][5]
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Natural History
Complication
- Tracheal compression[11][12]
- Cough[11]
- Infection[11][3]
- Hemoptysis[11]
- Superior vena cava syndrome[12]
- Pneumothorax[12]
- Pleurisy[12]
- Pneumonia[12]
- Lymphangioma[3]
- Haemorrhage[3]
- Neoplasia(adenocarcinoma, mucoepidermoid carcinoma, anaplastic carcinoma, and leiomyosarcoma)[3][5]
- Rupture[5]
Prognosis
Diagnosis
Clinical presentation of bronchogenic cyst depends on the age of the patient and the location involved.
- In children, Cervical and Mediastinal bronchogenic cyst presents as respiratory distress, increasing stridor, feeding difficulties.[3][11]
- In adults, Cervical and Mediastinal bronchogenic cyst presents with chest pain, cough,[6] progressive dysphagia and dyspnea[5]
- On numerous occasions, there is no obvious positive characteristics on physical exams in patients suspected of bronchogenic cyst.
- Increased serum tumor marker CA125 and CA199[6]
- An esophageal bronchogenic cyst is evidenced by esophagography
- CT scan shows an ovoid and well-defined encapsulated low-density mass with no contrast enhancement.[3][6]
- Cystic lesion by relatively high-signal intensity.[6]
- Bronchogenic cyst has varied appearance, endoscopic ultrasound is a valuable option for diagnosis and surveillance. Ultrasonography shows a hyperechoic fluid filled solid mass.[3][6]
- Biopsy and microscopic studies - Definitive diagnosis is based on histological findings after excision of the cyst.[5] and finding ciliated columnar epithelium lining the cyst wall.[6]
- Gastroendoscopy and endoscopic ultrasonography to clarify abdominal anatomic relations.[6]
Treatment
Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies
Complete surgical resection is curative. Risk during surgery is usually low, and excision aids confirmation of the diagnosis. Percutaneous catheter drainage or endoscopic ultrasonographic guided-fine needle aspiration[6] with sterile alcohol ablation has been used in selected high-risk patients, especially adults, but has no place in pediatric therapeutics.[3]
Surgery remains the best therapeutic option in children and is imperative when symptoms such as dyspnea or dysphagia as a result of compression of the trachea appear. After complete resection, recurrences have not been described.[3] Surgery can range from thoracotomy.[6]
Case Studies
Template:WikiDoc Sources
CME Category::Cardiology
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Maier HC (1948). "Bronchiogenic Cysts of the Mediastinum". Ann Surg. 127 (3): 476–502. doi:10.1097/00000658-194803000-00010. PMC 1513836. PMID 17859095.
- ↑ 2.0 2.1 2.2 Sarper A, Ayten A, Golbasi I, Demircan A, Isin E (2003). "Bronchogenic cyst". Tex Heart Inst J. 30 (2): 105–8. PMC 161894. PMID 12809250.
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 Teissier N, Elmaleh-Bergès M, Ferkdadji L, François M, Van den Abbeele T (2008). "Cervical bronchogenic cysts: usual and unusual clinical presentations". Arch Otolaryngol Head Neck Surg. 134 (11): 1165–9. doi:10.1001/archotol.134.11.1165. PMID 19015445.
- ↑ Wang W, Ni Y, Zhang L, Li X, Ke C, Lu Q; et al. (2012). "A case report of para-esophageal bronchogenic cyst with esophageal communication". J Cardiothorac Surg. 7: 94. doi:10.1186/1749-8090-7-94. PMC 3599576. PMID 23013612.
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Chuang KH, Huang TW, Cheng YL, Chen JC, Tzao C, Chang H; et al. (2007). "Esophageal bronchogenic cyst: a rare entity". Z Gastroenterol. 45 (9): 958–60. doi:10.1055/s-2007-963069. PMID 17874358.
- ↑ 6.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.09 Han C, Lin R, Yu J, Zhang Q, Zhang Y, Liu J; et al. (2016). "A Case Report of Esophageal Bronchogenic Cyst and Review of the Literature With an Emphasis on Endoscopic Ultrasonography Appearance". Medicine (Baltimore). 95 (11): e3111. doi:10.1097/MD.0000000000003111. PMC 4839937. PMID 26986156.
- ↑ 7.0 7.1 7.2 7.3 "StatPearls". 2020. PMID 30725658.
- ↑ Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID https://doi.org/10.1186/1749-8090-7-94 Check
|pmid=value (help). - ↑ Suda K, Sueyoshi R, Okawada M, Koga H, Lane GJ, Yamataka A; et al. (2015). "Completely intramural bronchogenic cyst of the cervical esophagus in a neonate". Pediatr Surg Int. 31 (7): 683–7. doi:10.1007/s00383-015-3720-1. PMID 26002606.
- ↑ Mehta RP, Faquin WC, Cunningham MJ (2004). "Cervical bronchogenic cysts: a consideration in the differential diagnosis of pediatric cervical cystic masses". Int J Pediatr Otorhinolaryngol. 68 (5): 563–8. doi:10.1016/j.ijporl.2003.12.015. PMID 15081229.
- ↑ 11.0 11.1 11.2 11.3 11.4 Ribet ME, Copin MC, Gosselin BH (1996). "Bronchogenic cysts of the lung". Ann Thorac Surg. 61 (6): 1636–40. doi:10.1016/0003-4975(96)00172-5. PMID 8651761.
- ↑ 12.0 12.1 12.2 12.3 12.4 Aktoğu S, Yuncu G, Halilçolar H, Ermete S, Buduneli T (1996). "Bronchogenic cysts: clinicopathological presentation and treatment". Eur Respir J. 9 (10): 2017–21. doi:10.1183/09031936.96.09102017. PMID 8902460.