P178 OCCASIONAL ECHOCARDIOGRAPHIC DIAGNOSIS OF BRONCHOGENIC CYST

Abstract

Abstract Bronchogenic cysts (BCs) are abnormal rounded formations associated with the tracheobronchial tree, that can cause recurrent infections or obstructive respiratory symptoms. They are often asymptomatic and can be discovered on occasional cardiac imaging. The treatment of bronchogenic cyst is controversial; some clinicians recommend surgical resection or transbronchial needle aspiration, others prefer a conservative attitude, reserving treatment for the possible appearance of symptoms or complications. We describe the case of a 54–year–old male patient which came to our observation in 2005, for the onset of intermittent angina pectoris. The first tests showed: no ECG alterations, mild hypokinesia of the inferolateral wall of the left ventricle with preserved systolic function on the echocardiogram, a modest increase in myocardial enzymes: total CK 731 U/L, CK–MB 40 U/L, CK–MB/CK ratio 5,4. The next day, the patient underwent coronary angiography and ramus intermedius PCI. However, the echocardiogram showed a rounded, anecogenic formation, 52 x 49 mm, behind the left atrium (Fig.1–2), which CT and MRI of the chest (Fig.3) diagnosed as BC in mediastinal location. Excluding the presence of neoplastic cells in the bronchoalveolar lavage fluid, a conservative strategy was agreed with the pulmonologists, choosing echocardiogram for follow–up. In the 17–year observation period, BC remained clinically silent, with no increase in size. Bronchogenic cysts are caused by an abnormal branching of the respiratory airways, that leads to the formation of segments separated from the tracheobronchial tree. About 80% of BCs are localized in the mediastinum, the remainder in the lung parenchyma. Unlike lung BCs, mediastinal BCs rarely communicate with the tracheobronchial tree and therefore usually do not undergo infectious processes. Mediastinal BCs localized near the carina of the trachea can cause compression symptoms (cough, dysphagia, dyspnoea). The other mediastinal BCs usually do not cause disorders. Knowledge of this rare congenital pulmonary disease is useful for echocardiographic differential diagnosis. Sometimes the cardiologist can play a role in the follow–up of this pathology.