Bronchogenic cyst
| 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: Joanna Ekabua, M.D. [2]
Synonyms and keywords: Bronchial cyst
Overview
Bronchogenic cyst is a rare benign congenital malformation of the tracheobronchial tree derived from the ventral aspect of the foregut. It 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. Patients with bronchogenic cyst may be asymptomatic or present with respiratory distress, increasing stridor, feeding difficulties, chest pain, cough, progressive dysphagia, odynophagia, purulent sputum, dyspnea, anorexia and/orweight loss. Radiologic findings are useful to differentiate bronchogenic cysts from other cysts but may they not always confirm the diagnosis. Diagnosis is confirmed by surgical excision, which is curative, and histological findings of ciliated columnar epithelial lining of the cyst.
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Bronchogenic cyst from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
The majority of patients with bronchogenic cyst are asymptomatic and are diagnosed during investigations for other pathologies.[1][2][3]
When symptomatic, clinical presentation of bronchogenic cyst depends on the age of the patient, size and the location of the cyst.[1][4]
In infants bronchogenic cyst presents with [5][6][7][4][8][9][10]
- respiratory distress
- Increasing stridor
- Reccurrent croup
- Feeding difficulties.
- Palpable neck mass
- Non-bilious emesis
In children and adults, bronchogenic cyst presents with
- Dull chest pain,[1][11][12][13] with radiation to the shoulder in diaphragmatic broncogenic cyst.[14][7]
- Cough[13] [11][15]
- Progressive dysphagia[1][13]
- Odynophagia[13]
- wheezing[1]
- Adobminal bloating[16]
- Fever[11]
- Palpable neck mass[4]
- purulent sputum[1]
- Hemoptysis[11]
- Dyspnea[17][7]
- Anorexia and/or weight loss[18]
- Dizziness[19]
- Paroxysmal supraventricular tachycardia[20]
- Atrioventricular block[21]
- Atrial and ventricular premature complexes[22]
- Memory impairment[23]
- Asthenia[23][24][25]
- Limping[25]
- Seizure and loss of consciousness[26]
- Sciatica[27]
- Back pain[24][28]
- Neuralgia[28]
- Urinary incontinence[24]
Physical examination of patients with bronchogenic cyst is usually normal. On rare occasions, the following signs can be seen
- Cough[13] [11][15]
- wheezing[1]
- Stridor[7]
- Hemoptysis[11]
- Dyspnea[17][7]
- Tracheal deviation[9]
- Fluid-thrill[29]
- Anorexia and/or weight loss[18]
- Fever[11]
- Asthenia[23][24][25]
- Foot drop[27]
- Atrophy[25]
- Heart murmur[30][22]
- Tenderness[24]
- Cutanous pigmentation[24]
- Negative knee and ankle reflexes[24]
- Numbness[24][31]
- Some patients with bronchogenic cyst may have elevated serum tumor makers CA125 and CA19-9, which is usually suggestive of progression/complication.[13][32]
Despite enhanced imaging modalities, a definitive diagnosis of bronchogenic cyst is challenging preoperatively.[13]
An x-ray with esophagography may be helpful in the diagnosis of bronchogenic cyst. Findings on an x-ray suggestive of bronchogenic cyst include:[6][11]
- Homogeneous non-calcified soft tissue density mass.
- Round to oval opacity
- Secondary excavation
- Cavity with or without levels
- Atelectasis
- Hydropneumothorax
CT scan may be helpful in the diagnosis of bronchogenic cyst. The density of bronchogenic cysts is variable from water density to high density due to blood, anthracotic pigment, increased calcium content, or increased protein content of the fluid.[33][34] Findings on CT scan suggestive of bronchogenic cyst is an
- Cysic mass with air-fluid levels[35]
- ovoid and well-defined encapsulated low-density cystic mass with no contrast enhancement.[5][13]
- Thin subtle walls
MRI may be helpful in the diagnosis of bronchogenic cyst. After contrast injection, enhancement of the cyst is frequently absent.[36][13][33][34] Findings on MRI suggestive of bronchogenic cyst include
- T1-weighted images show ipointense signal
- T2-weighted images show hyperintense signal.
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ultrasound may be helpful in the diagnosis of bronchogenic cyst. Finding on an ultrasound suggestive of bronchogenic cyst include
- On endobronchial ultrasound, an anechoic or hypoechoic fluid filled solid mass.[5][13][15]
- On transthoracic echocardiography revealing intracardiac cystic mass[21]
- On endoscopic ultrasonography, which demonstartes abdominal anatomic relations of the cyst[13]
Other diagnostic studies for bronchogenic cyst include:
- Excision and Hematoxylin and Eosin staining,[17] which demonstrates cillated columar epithelia cells is definitive for broncogenic cyst.[17][13][2][18]
- Immunohistochemical stainingof bronchogenic cyst of esophagus , whcich demonstartes a positive expression of CA199 and CA125.[13]
- Bronchoscopy, which demonstrates pink cystic mass with bronchial attachment[11]
- Gastroendoscopy which demonstartes abdominal anatomic relations of the cyst.[13][16]
- fluorodeoxyglucose-positron emission tomography to confirm cyst infection[37]
Treatment
Surgery is the mainstay of treatment for bronchogenic cyst even when the patients are asymptomatic,[2]conservative approach is not approved.[18] Surgery is imperative with symptoms such as [11]
- Dyspnea
- Dysphagia
- Pain
- Purulent sputum
- Hemoptysis
Most commonly used approaches for complete excision of bronchogenic cysts are[11][13][2][15]
Other procedures include
- Endoscopic submucosal tunnel dissection[2][13]
- Percutaneous catheter drainage or endoscopic ultrasonographic guided-fine needle aspiration[13] with sterile alcohol ablation has been used in selected high-risk patients, especially adults, but has no place in pediatric therapeutics.[5]
- video-assisted thorascopic surgery[14][13][15][38]
- Transtracheal needle aspiration[39]
- Craniotomy with resection for cranial bronchogenic cystcraniotomy with resection[23]
- Sternotomy for cardiac cyst[36]
- Laminectomy for intraspinal cyst[24][25]
- Marsupialisation[27]
Complete surgical resection is curative.[5][3] Risk during surgery is usually low, complications include but are not limited to persistent air leak,[11] pulmonary and vascular compressions, vascular, pleural, tracheobronchial, pulmonary, mediastinal and diaphragmatic adhesions,[18] inflammatory stenosis,[9] and thrid degree heart block.[36]
Case Studies
Template:WikiDoc Sources
CME Category::Cardiology
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 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 2.3 2.4 Yang X, Zong Y, Zhao HY, Wu YD, Ji M (2019). "Complete excision of esophageal bronchogenic cyst by endoscopic submucosal tunnel dissection: a case presentation". BMC Gastroenterol. 19 (1): 155. doi:10.1186/s12876-019-1072-3. PMC 6714396 Check
|pmc=value (help). PMID 31462259. - ↑ 3.0 3.1 Ramenofsky ML, Leape LL, McCauley RG (1979). "Bronchogenic cyst". J Pediatr Surg. 14 (3): 219–24. doi:10.1016/s0022-3468(79)80474-1. PMID 480084.
- ↑ 4.0 4.1 4.2 Jiang JH, Yen SL, Lee SY, Chuang JH (2015). "Differences in the distribution and presentation of bronchogenic cysts between adults and children". J Pediatr Surg. 50 (3): 399–401. doi:10.1016/j.jpedsurg.2014.06.008. PMID 25746696.
- ↑ 5.0 5.1 5.2 5.3 5.4 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.
- ↑ 6.0 6.1 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.
- ↑ 7.0 7.1 7.2 7.3 7.4 Hsu CG, Heller M, Johnston GS, Felberbaum M (2017). "An Unusual Cause of Airway Compromise in the Emergency Department: Mediastinal Bronchogenic Cyst". J Emerg Med. 52 (3): e91–e93. doi:10.1016/j.jemermed.2016.11.004. PMID 27986331.
- ↑ Lin JS, Yu YR, Chiou EH, Chumpitazi BP, Schady DA, Brandt ML (2017). "Intramural esophageal bronchogenic cyst mimicking achalasia in a toddler". Pediatr Surg Int. 33 (1): 119–123. doi:10.1007/s00383-016-3994-y. PMID 27822780.
- ↑ 9.0 9.1 9.2 Thaller P, Blanchet C, Badr M, Mesnage R, Leboucq N, Mondain M; et al. (2015). "Neonatal respiratory distress syndrome revealing a cervical bronchogenic cyst: a case report". BMC Pediatr. 15: 72. doi:10.1186/s12887-015-0363-2. PMC 4491209. PMID 26112048.
- ↑ Brugha R, Semple T, Cook J, Dusmet M, Rosenthal M (2018). "Two Bronchogenic Cysts Causing Tracheal Stenosis in an Infant". Am J Respir Crit Care Med. 197 (2): 261–262. doi:10.1164/rccm.201708-1611IM. PMID 29099998.
- ↑ 11.00 11.01 11.02 11.03 11.04 11.05 11.06 11.07 11.08 11.09 11.10 11.11 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.
- ↑ Chumakova M, Morris-Stiff G, Khachaturov V, Ibrahim S (2016). "Bronchogenic cyst arising from the crus of the left hemidiaphragm". BMJ Case Rep. 2016. doi:10.1136/bcr-2015-213658. PMC 4840741. PMID 27068723.
- ↑ 13.00 13.01 13.02 13.03 13.04 13.05 13.06 13.07 13.08 13.09 13.10 13.11 13.12 13.13 13.14 13.15 13.16 13.17 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.
- ↑ 14.0 14.1 Legras A, Mordant P, Gibault L, Hernigou A, Le Pimpec Barthes F, Riquet M (2014). "[Diaphragmatic bronchogenic cyst: an exceptional location]". Rev Pneumol Clin. 70 (6): 357–61. doi:10.1016/j.pneumo.2014.05.002. PMID 25131363.
- ↑ 15.0 15.1 15.2 15.3 15.4 Ayub II, Balakrishnan H, Arshad AM, Manimaran N, Thangaswamy D, Chockalingam C (2019). "A 44-Year-Old Man With Nonproductive Cough and Sensation of Heaviness Over the Upper Chest". Chest. 155 (3): e65–e68. doi:10.1016/j.chest.2018.09.035. PMID 30846076.
- ↑ 16.0 16.1 Gou Y, Wang Y, Fang H, Xu X, Yu W, Zhang K; et al. (2015). "Bronchogenic cyst in the hepatogastric ligament masquerading as an esophageal mesenchymal tumor: a case report". Int J Clin Exp Pathol. 8 (11): 15307–11. PMC 4713671. PMID 26823885.
- ↑ 17.0 17.1 17.2 17.3 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.
- ↑ 18.0 18.1 18.2 18.3 18.4 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.
- ↑ Xu Q, Feng Y, Ye K, Zhou Y, Zhan R (2015). "Bronchogenic cyst in left anterior cranial fossa". Neurology. 84 (11): 1181–2. doi:10.1212/WNL.0000000000001368. PMID 25780019.
- ↑ Mega S (2015). "[Anterior Mediastinal Bronchogenic Cyst Associated with paroxysmal supraventricular tachycardia ; Report of a Case]". Kyobu Geka. 68 (10): 871–3. PMID 26329634.
- ↑ 21.0 21.1 Miwa E, Tani T, Okada Y, Furukawa Y (2017). "A rare cardiac tumor: Bronchogenic cyst of interatrial septum". Echocardiography. 34 (3): 474–475. doi:10.1111/echo.13445. PMID 28139004.
- ↑ 22.0 22.1 Blesneac C, Horvath E, Muntean I, Benedek T, Toganel R (2018). "Intracardiac bronchogenic cyst associated with ventricular septal defect: an extremely rare feature in children". Eur Heart J Cardiovasc Imaging. 19 (9): 1074. doi:10.1093/ehjci/jey078. PMID 29897508.
- ↑ 23.0 23.1 23.2 23.3 Bian B, Yu M, Liu S, Li S, Wei Y, Zhang B (2019). "A suprasellar bronchogenic cyst: A case report". Medicine (Baltimore). 98 (30): e16650. doi:10.1097/MD.0000000000016650. PMC 6709100 Check
|pmc=value (help). PMID 31348319. - ↑ 24.0 24.1 24.2 24.3 24.4 24.5 24.6 24.7 24.8 Zou MX, Hu JR, Kang YJ, Li J, Lv GH, She XL (2015). "Bronchogenic cyst of the conus medullaris with spinal cord tethering: a case report and review of the literature". Int J Clin Exp Pathol. 8 (4): 3937–42. PMC 4466965. PMID 26097578.
- ↑ 25.0 25.1 25.2 25.3 25.4 Lee HD, Han SH, Park SB, Ko Y, Lee KH (2017). "An intradural extramedullary bronchogenic cyst in the thoracolumbar spine: A case report". Medicine (Baltimore). 96 (50): e9263. doi:10.1097/MD.0000000000009263. PMC 5815783. PMID 29390371.
- ↑ Khawar M, Elmahrouk A, Chaikhouni A (2016). "Air embolism during air flight in a passenger with bronchogenic cyst". J Thorac Cardiovasc Surg. 152 (1): e1–2. doi:10.1016/j.jtcvs.2016.02.014. PMID 26969135.
- ↑ 27.0 27.1 27.2 Candy N, Young A, Devadass A, Dean A, McMillen J, Trivedi R (2017). "Dual lumbar bronchogenic and arachnoid cyst presenting with sciatica and left foot drop". Acta Neurochir (Wien). 159 (10): 2029–2032. doi:10.1007/s00701-017-3284-z. PMID 28762109.
- ↑ 28.0 28.1 Atoini F, Ouarssani A, Ouadnouni Y, Smahi M (2016). "Unusual mode of presentation of intrathoracic bronchogenic cyst: A double location". Respir Med Case Rep. 17: 12–6. doi:10.1016/j.rmcr.2015.10.001. PMC 4821250. PMID 27222776.
- ↑ Nachef Z, Harris K, Dhillon SS (2018). "Bronchogenic Cyst: Fluid-thrill Sign on Endobronchial Ultrasound". J Bronchology Interv Pulmonol. 25 (3): 224–227. doi:10.1097/LBR.0000000000000473. PMID 29389833.
- ↑ Hayabuchi Y, Sakata M, Kagami S (2015). "Bronchogenic cyst compressing the pulmonary artery and the left atrium". Eur Heart J Cardiovasc Imaging. 16 (7): 746. doi:10.1093/ehjci/jev059. PMID 25750196.
- ↑ Chen F, Marx S, Zhang C, Cao J, Yu Y, Chen D (2019). "Intramedullary bronchogenic cyst in the foramen magnum region accompanied with syringomyelia: A case report and literature review". Medicine (Baltimore). 98 (5): e14353. doi:10.1097/MD.0000000000014353. PMC 6380722. PMID 30702626.
- ↑ Wang M, He X, Qiu X, Tian C, Li J, Lv M (2017). "Retroperitoneal bronchogenic cyst resembling an adrenal tumor with high levels of serum carbohydrate antigen 19-9: A case report". Medicine (Baltimore). 96 (31): e7678. doi:10.1097/MD.0000000000007678. PMC 5626148. PMID 28767594.
- ↑ 33.0 33.1 McAdams HP, Kirejczyk WM, Rosado-de-Christenson ML, Matsumoto S (2000). "Bronchogenic cyst: imaging features with clinical and histopathologic correlation". Radiology. 217 (2): 441–6. doi:10.1148/radiology.217.2.r00nv19441. PMID 11058643.
- ↑ 34.0 34.1 Chen TJ, Liao CH, Shen TC (2018). "Bronchogenic cyst". QJM. 111 (12): 905. doi:10.1093/qjmed/hcy140. PMID 29939368.
- ↑ 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.
- ↑ 36.0 36.1 36.2 Olsen M, Mitchell TA, Percival TJ, Helsel BS (2015). "Interatrial Bronchogenic Cyst Resection". Ann Thorac Surg. 100 (2): 709–11. doi:10.1016/j.athoracsur.2014.10.025. PMID 26234845.
- ↑ Yildiz H, Reichwein R, Poncelet A, Lacroix V, D'abadie P, Ghaye B; et al. (2019). "An unusual case of cardiac tamponade: Bronchogenic cyst infection due to Salmonella bredeney". J Infect Chemother. 25 (2): 151–153. doi:10.1016/j.jiac.2018.07.012. PMID 30098916.
- ↑ Jung HS, Kim DK, Lee GD, Sim HJ, Choi SH, Kim HR; et al. (2014). "Video-assisted thoracic surgery for bronchogenic cysts: is this the surgical approach of choice?". Interact Cardiovasc Thorac Surg. 19 (5): 824–9. doi:10.1093/icvts/ivu228. PMID 25038917.
- ↑ Cohn JR, Wechsler R, Zawid J, Brodovsky HS (1987). "Resolution of a mediastinal cyst by transtracheal needle aspiration". Pa Med. 90 (3): 64, 66. PMID 3562032.