Bronchogenic cyst overview
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Joanna Ekabua, M.D. [2]
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
There is limited information about the historical perspective of bronchogenic cyst.
Classification
Bronchogenic cyst can be classified based on location; pulmonary and extrapulmonary.[1][2]
Pathophysiology
It is thought that bronchogenic cyst is the result of abnormal budding of the ventral portion of the primitive foregut between days 26 - 40 of gestation.
Causes
The cause of bronchogenic cysts is undetermined.
Differentiating Bronchogenic cyst from other Diseases
Differentiating bronchogenic cyst from lung abcess, thymic cyst, and esophageal duplication cysts.
Bronchogenic cyst epidemiology and demographics|Epidemiology and Demographics
There is no racial predilection to bronchogenic cyst. Bronchogenic cyst is slightly more prevalent in men and often remain undetected until the third or fourth decade of life.
Risk factors
There are no established risk factors for bronchogenic cyst.
Screening
There is insufficient evidence to recommend routine screening for bronchogenic cyst as it is usually an incidental finding.
Natural history, complications and prognosis
Natural History
The symptoms of bronchogenic cyst usually develop in the third to fourth decade of life and start with symptoms such as
- Dyspnea[2][3][4][5]
- Chronic dry cough[2][3][5]
- Rhinitis[6]
- Chest discomfort/pain[2][7][3][4]
- Neck pain[8]
- Flu-like symptoms and Fever[2][3][4]
- Purulent sputum[2]
- Abdominal discomfort
- Limb weakness
- Paroxysmal supraventricular tachycardia[9]
- Atrioventricular block[10]
- Memory impairment[11]
- Asthenia[11][12][13]
- Seizure and loss of consciousness[14]
- Dizziness[15]
- Lower back pain[12]
- Urinary incontinence[12]
Complication
Common complications of bronchogenic cyst include
- Tracheal compression[16][17]
- Esophageal compression[2]
- Cough[16]
- Infection/abscess[16][18][19][6]
- Hemoptysis[2][16]
- Superior vena cava syndrome[17][20][21]
- Pneumothorax[2][17]
- Pleurisy[17]
- Pneumonia[2][17]
- Lymphangioma[18]
- Haemorrhage[18][19]
- Neoplasia(adenocarcinoma, mucoepidermoid carcinoma, anaplastic carcinoma, and leiomyosarcoma)[18][22][23][19]
- Rupture[2][22][19]
- Air embolism[14]
- Cardiac tamponade[4]
- Ventricular septal defect[24]
- syringomyelia[8]
Prognosis
Prognosis is generally good,[18] a Morbidity & Mortality rate of 20% has been recorded in older patients treated for bronchogenic cyst.[25]
Diagnostic Study of Choice
Excision and Hematoxylin and Eosin staining.
Diagnostic results
Cillated columar epithelia cells is definitive for broncogenic cyst.[22][23][19][17]
Diagnostic criteria
Cystic mass producing compressive symptoms.
History and symptoms
The majority of patients with bronchogenic cyst are asymptomatic and are diagnosed during investigations for other pathologies.[1][19][26]
When symptomatic, clinical presentation of bronchogenic cyst depends on the age of the patient, size and the location of the cyst.[1][27]
In infants bronchogenic cyst presents with [18][16][28][27][29][30][31]
- 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][2][7][23] with radiation to the shoulder in diaphragmatic broncogenic cyst.[32][28]
- Cough[23] [2][33]
- Progressive dysphagia[1][23]
- Odynophagia[23]
- wheezing[1]
- Adobminal bloating[34]
- Fever[2]
- Palpable neck mass[27]
- purulent sputum[1]
- Hemoptysis[2]
- Dyspnea[22][28]
- Anorexia and/or weight loss[17]
- Dizziness[15]
- Paroxysmal supraventricular tachycardia[9]
- Atrioventricular block[10]
- Atrial and ventricular premature complexes[24]
- Memory impairment[11]
- Asthenia[11][12][13]
- Limping[13]
- Seizure and loss of consciousness[14]
- Sciatica[35]
- Back pain[12][36]
- Neuralgia[36]
- Urinary incontinence[12]
Physical examinaton
Physical examination of patients with bronchogenic cyst is usually normal. On rare occasions, the following signs can be seen
- Cough[23] [2][33]
- wheezing[1]
- Stridor[28]
- Hemoptysis[2]
- Dyspnea[22][28]
- Tracheal deviation[30]
- Fluid-thrill[37]
- Anorexia and/or weight loss[17]
- Fever[2]
- Asthenia[11][12][13]
- Foot drop[35]
- Atrophy[13]
- Heart murmur[20][24]
- Tenderness[12]
- Cutanous pigmentation[12]
- Negative knee and ankle reflexes[12]
- Numbness[12][8]
Laboratory findings
An elevated serum tumor makers CA125 and CA19-9, which is usually suggestive of progression/complication.[23][38]
CT
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. Findings on CT scan suggestive of bronchogenic cyst is an
- Cysic mass with air-fluid levels.
- ovoid and well-defined encapsulated low-density cystic mass with no contrast enhancement.
- Thin subtle walls.
MRI
MRI may be helpful in the diagnosis of bronchogenic cyst. After contrast injection, enhancement of the cyst is frequently absent. Findings on MRI suggestive of bronchogenic cyst include
- T1-weighted images show ipointense signal
- T2-weighted images show hyperintense signal.
Ultrasound
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.
- On transthoracic echocardiography revealing intracardiac cystic mass.
- On endoscopic ultrasonography, which demonstartes abdominal anatomic relations of the cyst.
Other Diagnostic Studies
Other diagnostic studies for bronchogenic cyst include: Excision and Hematoxylin and Eosin staining, which demonstrates ciliated columar epithelia cells is definitive for bronchogenic cyst
- Immunohistochemical staining of bronchogenic cyst of the esophagus , which demonstrates a positive expression of CA199 and CA125.
- Bronchoscopy, which demonstrates pink cystic mass with bronchial attachment
- Gastroendoscopy which demonstartes abdominal anatomic relations of the cyst.
- fluorodeoxyglucose-positron emission tomography to confirm cyst infection.
Treatment
Medical therapy
The mainstay of treatment for bronchogenic cyst is surgery.
Surgery
Surgery is the mainstay of treatment for bronchogenic cyst even when the patients are asymptomatic, a conservative approach is not approved.
Primary prevention
There are no established measures for the primary prevention of bronchogenic cyst.
Secondaryy prevention
There are no established measures for the secondary prevention of bronchogenic cyst.
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Maier HC (1948). "Bronchiogenic Cysts of the Mediastinum". Ann Surg. 127 (3): 476–502. doi:10.1097/00000658-194803000-00010. PMC 1513836. PMID 17859095.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 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.
- ↑ 3.0 3.1 3.2 3.3 Mesland JB, Gérard L, Van Caenegem O, Castanares-Zapatero D (2018). "Bronchogenic cyst infection presenting as pleuropericarditis". BMJ Case Rep. 2018. doi:10.1136/bcr-2018-225081. PMC 6011476. PMID 29895549.
- ↑ 4.0 4.1 4.2 4.3 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.
- ↑ 5.0 5.1 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.
- ↑ 6.0 6.1 DiBardino DM, Brenner K (2017). "Bronchogenic Cyst Abscess". J Bronchology Interv Pulmonol. 24 (3): 31–32. doi:10.1097/LBR.0000000000000375. PMID 28696968.
- ↑ 7.0 7.1 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.
- ↑ 8.0 8.1 8.2 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.
- ↑ 9.0 9.1 Mega S (2015). "[Anterior Mediastinal Bronchogenic Cyst Associated with paroxysmal supraventricular tachycardia ; Report of a Case]". Kyobu Geka. 68 (10): 871–3. PMID 26329634.
- ↑ 10.0 10.1 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.
- ↑ 11.0 11.1 11.2 11.3 11.4 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. - ↑ 12.00 12.01 12.02 12.03 12.04 12.05 12.06 12.07 12.08 12.09 12.10 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.
- ↑ 13.0 13.1 13.2 13.3 13.4 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.
- ↑ 14.0 14.1 14.2 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.
- ↑ 15.0 15.1 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.
- ↑ 16.0 16.1 16.2 16.3 16.4 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.
- ↑ 17.0 17.1 17.2 17.3 17.4 17.5 17.6 17.7 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.
- ↑ 18.0 18.1 18.2 18.3 18.4 18.5 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.
- ↑ 19.0 19.1 19.2 19.3 19.4 19.5 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. - ↑ 20.0 20.1 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.
- ↑ Parsons C, Zhao CB, Huang J (2019). "Gigantic Pericardial Bronchogenic Cyst Compressing Superior Vena Cava and Coronary Artery". Anesthesiology. 131 (3): 667. doi:10.1097/ALN.0000000000002739. PMID 31008767.
- ↑ 22.0 22.1 22.2 22.3 22.4 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.
- ↑ 23.0 23.1 23.2 23.3 23.4 23.5 23.6 23.7 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.
- ↑ 24.0 24.1 24.2 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.
- ↑ Makhija Z, Moir CR, Allen MS, Cassivi SD, Deschamps C, Nichols FC; et al. (2011). "Surgical management of congenital cystic lung malformations in older patients". Ann Thorac Surg. 91 (5): 1568–73, discussion 1573. doi:10.1016/j.athoracsur.2011.01.080. PMID 21420068.
- ↑ 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.
- ↑ 27.0 27.1 27.2 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.
- ↑ 28.0 28.1 28.2 28.3 28.4 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.
- ↑ 30.0 30.1 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.
- ↑ 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.
- ↑ 33.0 33.1 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.
- ↑ 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.
- ↑ 35.0 35.1 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.
- ↑ 36.0 36.1 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.
- ↑ 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.