Clinical Presentation, Radiological Features, and Surgical Treatment of Bronchogenic Cysts

Abstract

Objective: To study the differences in the clinical presentation and radiological features of intrapulmonary and mediastinal bronchogenic cysts. Materials and Methods: From 1989 to 2002, 15 patients with bronchogenic cysts underwent surgery at our hospital. Their medical records and radiographs were reviewed. Follow-up studies were obtained in the outpatient department. Results: The patients included 9 males and 6 females whose ages ranged from 3 months to 76 years, with a mean age of 36.3 years. The lesions were intrapulmonary in 7 (47%) patients and mediastinal in 8 (53%). Eleven (73%) of the 15 bronchogenic cysts had symptoms: 6 (86%) of the 7 intrapulmonary bronchogenic cysts and 5 (63%) of the 8 mediastinal bronchogenic cysts (p=0.000). Thirteen (87%) cysts were initially discovered by chest radiography. The 2 undetected cysts were located in the mediastinum. All lesions were detectable on computed tomographic scans. Of the intrapulmonary bronchogenic cysts, 4 (57%) appeared air-containing on radiographs, and 3 presented as solid masses. All detected mediastinal cysts appeared as solid masses without air content (p=0.000). Four patients underwent esophagography, alone or combined with endoscopy, to exclude epithelial lesions of the esophagus. Intrapulmonary cysts were treated with pulmonary wedge resection (n=4), lobectomy (n=2), or segmentectomy (n=1). Excision of the mediastinal cysts was completed by video-assisted thoracic surgery (n=4), posterolateral thoracotomy (n=3), or mediastinoscopy (n=1). The follow-up period ranged from 1 week to 1 year, with a mean of 3.8 months. No surgical mortality occurred. All patients were cured, but one patient with a small, occult satellite mediastinal cyst required further observation. Conclusions: A large proportion of intrapulmonary bronchogenic cysts cause more symptoms than mediastinal cysts. Radiological features reveal a higher incidence of air-content in intrapulmonary bronchogenic cysts, compared with mediastinal cysts which present as solid masses. Surgical excision is a reliable treatment to achieve cure for those patients with bronchogenic cysts.