Bronchogenic Cyst In Adult Research Articles

Comparative outcomes of video-assisted thoracoscopic surgery versus open surgery for bronchogenic cysts in adults: a retrospective cohort study.

Open thoracotomy has been the traditional surgical approach for patients with bronchogenic cysts (BCs). This study aimed to evaluate the safety and efficacy of video-assisted thoracoscopic surgery (VATS) compared to open surgery for the treatment of BCs in adults. This single-institution, retrospective cohort study included 117 consecutive adult patients who underwent VATS (group A) or open surgery (group B) for BC resection between February 2019 and January 2023. Data regarding clinical history, operation duration, length of hospital stay, 30-day mortality, and recurrence during follow-up were collected and analyzed. Of the total cohort, 103 (88.0%) patients underwent VATS, while 14 (12.0%) patients underwent open surgery. Patients' age in group B were much older than group A (P=0.014), and no significant differences in other demographic and baseline clinical characteristics were observed between the groups. The VATS group had shorter median operation duration (96 vs. 149.5 min, P<0.001) and shorter mean length of hospital stay (5.0±5.5 vs. 8.6±4.0 days, P<0.001). One death occurred in the open surgery group. During a median follow-up of 34 (interquartile range, 20.8-42.5) months, no instances of BC recurrence were observed in either group. Compared to open surgery, VATS is also a safe and efficacious approach for treating BCs in adults. What's more, VATS offered shorter operative times and hospital stays. Considering the minimally invasive, VATS may be a better choice in most patients with bronchial cysts.

INFECTED SIMULTANEOUS MEDIASTINAL BRONCHOGENIC CYST AND ESOPHAGEAL DUPLICATION CYST MASQUERADING AS A LUNG ABSCESS

TOPIC: Genetic and Developmental Disorders TYPE: Fellow Case Reports INTRODUCTION: Bronchogenic and esophageal duplication cysts are rare but significant developmental anomalies. We present a case with both types of cyst in a single mass mimicking a lung abscess with a protracted treatment course. CASE PRESENTATION: A healthy 26-year-old female was admitted with onset of left sided pleuritic chest pain and fever over 24 hours. Her exam was remarkable for fever and tachycardia; she had elevated markers of infection. Computed tomography (CT) of chest revealed a well-demarcated cystic mass in the left hemithorax with an air-fluid level. She had no prior chest imaging and denied aspiration events or substance use. She was thought to have an intraparenchymal lung abscess, and underwent CT guided aspiration with the drainage of frank purulent material. Because of suspected intraparenchymal location no drain was placed. Fluid cultures and cytology were negative but her sputum grew mucoid pseudomonas aeruginosa, which was an atypical pathogen in this patient. She was treated with four weeks of intravenous cefepime, and two weeks of levofloxacin and metronidazole, with serial imaging. Pleuritic chest pain persisted despite regression of the lesion over a 10-month period (Figures 1-3); after which she underwent resection through a left video-assisted thoracic surgical approach. Intraoperatively, a large densely adherent inflammatory lesion was connected to the esophagus without intraluminal connection. Thick purulent fluid from the cyst was sent for culture and cytology, which were again negative. Pathology of the cystic mass was consistent with an esophageal duplication cyst (EC) (Figure 4B) with an additional noncommunicating bronchogenic cyst (BC) (Figure 4A). At 6months follow-up visit, she was doing well and free of symptoms. DISCUSSION: To our knowledge this is the first case report of de-novo infected dual BC/EC in an adult. Our case highlights the need for consideration of congenital cysts while working up lung abscesses. The diagnosis may be difficult without surgical resection, as characteristic imaging findings are missing in up to half of cases. 1There is likely a role for aspiration of the cyst for both diagnostic and therapeutic purposes, however efficacy and safety data are limited.2 The optimal timing of cyst resection is also not clear, especially in asymptomatic cysts. There is a minimal evidence to support universal surgical resection, though infected and symptomatic cysts will continue to need surgical intervention. 2,3 CONCLUSIONS: Infected congenital cysts can present a diagnostic and therapeutic challenge. Atypical presentations, and lack of improvement with appropriate therapy, are important clues to the diagnosis. REFERENCE #1: St-Georges R, Deslauriers J, Duranceau A, Vaillancourt R, Deschamps C, Beauchamp G, Pagé A, Brisson J. Clinical spectrum of bronchogenic cysts of the mediastinum and lung in the adult. Ann Thorac Surg 1991; 52:6–13. REFERENCE #2: Kirmani B, Kirmani B, Sogliani F. Should asymptomatic bronchogenic cysts in adults be treated conservatively or with surgery? Interact Cardiovasc Thorac Surg. 2010 Nov; 11(5): 649-59. REFERENCE #3: Fievet L, Gossot D, de Lesquen H, Calabre C, Merrot T, Thomas P, Becmeur F, Grigoroiu M. Resection of bronchogenic cysts in symptomatic versus asymptomatic patients: an outcome analysis, The Annals of Thoracic Surgery (2020) DISCLOSURES: no disclosure on file for Gary Hochhheiser; No relevant relationships by Obieze Nwanna Nzewunwa, source=Web Response No relevant relationships by Edmund Sears, source=Web Response No relevant relationships by Hilamber Subba, source=Web Response

BRONCHOGENIC CYST: A TALE OF THE THIRD RECURRENCE

SESSION TITLE: Medical Student/Resident Cardiothoracic Surgery Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Bronchogenic cysts (BCs) are singular congenital variances that surface early from anomalous budding of the maturing respiratory system between the 26th and 40th day of gestation (1). Most BCs are asymptomatic until they compress the surrounding structures. BCs are commonly seen in the mediastinum or intrapulmonary; with a previously reported prevalence of 1 per 42,000 and 1 per 68,000 admissions. They account for 50% to 60% of all mediastinal cysts. If incomplete resected, there is very high recurrence rate (2). We report a patient with second recurrence of mediastinal BC noted 18 years after initial drainage without resection. CASE PRESENTATION: A 57-year-old female with history of biopsy-proven BC with mediastinoscopy drainage followed by first recurrence treated with thoracoscopic drainage. Symptoms at presentation included three days of chest pain radiating between the scapula, associated with shortness of breath, low grade fever, and a dry cough. Vital signs were stable and lab-work was remarkable for WBC of 15.03 K/mm3 with 1% immature granulocytes. Chest x-ray showed a right paratracheal soft tissue density measuring 4.5 cm. Chest CT showed a large low-attenuation mass measuring 8 x 4.8 cm in the mediastinum region with 23 Hounsfield unit density (Image 1,2). Patient underwent video-assisted thoracoscopy converted to right thoracotomy for incision and drainage with sclerotherapy of the BC. Biopsy showed benign fibrous tissue with respiratory epithelium consistent with BC without atypia (Image 3). No growth was appreciated on stain and culture. Serial chest x-rays prior to discharge showed resolution of the soft tissue density. Improvement of respiratory symptoms upon surgery and treatment of community-acquired pneumonia with Rocephin 1gm IV QD and Azithromycin 500mg IV QD for five days. DISCUSSION: With the help of this case report we hope to shed light on the fact that symptomatic cysts should be resected either by thoracotomy or via video-assisted thoracoscopy (VAT) regardless of patient age, unless surgical risks are unacceptably high, as in our patient due to proximity of prominent vessels (3). Although many asymptomatic cases have been reported, a number of complications with BCs have been described, with infection being the most common followed by respiratory obstruction. While there has been a recent rise in the use of thoracoscopic techniques for resection of bronchogenic cysts in adults, one should not forget about patients with high surgical risks. The benefits of thoracoscopy drainage are decreased scarring, reduced pain, and shorter hospitalization (4). CONCLUSIONS: If incomplete resection or drainage is done, as seen in this patient, then residual mucosa should be treated by toxic agents or electrocautery (5). We propose serial imaging to monitor for recurrence when incomplete resection or drainage is done, as no current guidelines are present. Reference #1: 1) Reichelt O, Grieser T, Wunderlich H, Möller A, Schubert J. Bronchogenic cyst. A rare differential diagnosis of retroperitoneal tumors. Urol Int. 2000;64(4):216-219. Reference #2: 2) Limaïem F, Ayadi-Kaddour A, Djilani H, Kilani T, El Mezni F. Pulmonary and mediastinal bronchogenic cysts: a clinicopathologic study of 33 cases. Lung. 2008;186(1):55-61. Reference #3: 3) McAdams HP, Kirejczyk WM, Rosado-de-Christenson ML, Matsumoto S. Bronchogenic cyst: imaging features with clinical and histopathologic correlation. Radiology. 2000;217(2):441-446. 4) Lee DH, Park CK, Kum DY, Kim JB, Hwang I. Clinical characteristics and management of intrathoracic bronchogenic cysts: a single center experience. Korean J Thorac Cardiovasc Surg. 2011;44(4):279-284. [5] Rice DC, Putnam JB. Recurrent bronchogenic cyst causing recurrent laryngeal nerve palsy. Eur J Cardiothorac Surg 2002;21:561–3. DISCLOSURES: No relevant relationships by Loui Abdelghani, source=Web Response No relevant relationships by Hesham Afify, source=Web Response No relevant relationships by George Alvarez, source=Web Response No relevant relationships by Manuel Carrazana, source=Web Response No relevant relationships by Maria Wallis-Crespo, source=Web Response

Intralobar pulmonary sequestration associated with bronchogenic cyst in adult

Pulmonary sequestration and mediastinal bronchogenic cysts are rare but well known to thoracic surgeons. However, their association is exceptional. We report such a case in a young adult. The common origin of these 2 malformations is discussed.

Bronchogenic cysts in adults: frequently mistaken for a solid mass on computed tomography

Bronchogenic cysts are congenital malformations and are often detected in asymptomatic patients as an incidental finding. Growth can cause compression of airways and vessels, resulting in clinical symptoms and possible complications. On computed tomography (CT) scans, bronchogenic cysts frequently have the appearance of a solid tumor. We describe diagnostic strategy and management for patients with bronchogenic cysts. Retrospective case study of 11 adults diagnosed with a bronchogenic cyst. The CT scan of all patients was revised and localization, size, Hounsfield Units (HU), and appearance (cystic or solid) of the lesions were reported. Lesions were arbitrarily considered cystic or solid when the radiographic density was below or above 20 HU, respectively. Eleven adults with a bronchogenic cyst were followed for at least 2 years after diagnosis. Eight of 11 detected lesions were judged as a solid lesion, based on the radiographic density (in HU) on CT images. Nine of 11 patients were treated by surgical resection. Two asymptomatic patients were not operated and remained asymptomatic without enlargement of the cysts during 2 years follow-up. Complications of resection were post-operative bleeding (n = 1), recurrent pneumothorax (n = 1), and recurrence of the cyst (n = 1). No mortality was observed. Bronchogenic cysts are frequently mistaken for a solid mass on CT scans. Further differentiation can be made by MRI or EUS when CT is inconclusive.

Should asymptomatic bronchogenic cysts in adults be treated conservatively or with surgery?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether asymptomatic bronchogenic cysts in adults require surgery or whether they can be adequately managed with conservative treatment or observation only. Altogether more than 310 papers were found using the reported search of which 23 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The papers identified included 683 adult patients with bronchogenic cysts. There was a substantial variation between the papers in the proportion of patients presenting with symptoms (6-79%), and all patients with symptoms were managed surgically. The majority of asymptomatic patients underwent empirical surgery to prevent the development of symptoms, to confirm the diagnosis and to rule out malignant transformation. A total of 74 asymptomatic patients were treated conservatively or had definitive diagnosis or treatment delayed. The longest period of observation was 22years. In total, 33 (45%) of asymptomatic patients eventually developed symptoms requiring surgery. There was no evidence to suggest that surgery following a cyst-related complication increased the postoperative morbidity or mortality, although it was noted to increase the technical difficulty of the procedure. There were no descriptions of misdiagnosis of malignancy as bronchogenic cyst, but 5 (0.7%) of the 683 cysts studied were found to be associated with malignant cells in the cyst wall. The figures cited, however, represent only symptomatic or incidental presentations. As the prevalence of these otherwise benign entities is not known, the rates of progression to symptoms and associated malignancy may be lower than those described. We would advocate informing asymptomatic patients diagnosed with bronchogenic cyst of the 20% morbidity of surgery whether immediate or delayed, the 45% risk of developing symptoms, some of which may be serious, and the 0.7% risk of malignancy. Should patients opt for conservative management, this can be offered only if close long-term follow-up can be guaranteed.

Thoracoscopic resection of mediastinal bronchogenic cysts in adults

Bronchogenic cysts are uncommon congenital anomalies of foregut origin usually located within the mediastinum and the lung and rarely diagnosed in adults. Surgical excision is recommended to establish diagnosis based on histologic examination, alleviate symptoms if present, and prevent future complications. Thoracoscopic approach is becoming the primary therapeutic option. Between January 1995 and July 2008, 30 patients with mediastinal bronchogenic cyst (MBC) underwent thoracoscopic operation (19 male, 11 female with a mean age of 39 years, range 19-59 years). Symptoms were present in 11 patients (37). The cysts averaged 5.2 cm in their greatest diameter (range 3-10.5 cm). In two cases thoracoscopy was converted to thoracotomy because of major pleural adhesions. There were no operative deaths and no intra-operative complications. Postoperative course was uneventful in all cases and the 28 patients who underwent thoracoscopy were discharged after a mean of 3.7 days (range 2-5 days). Considering the low conversion and complication rate, thoracoscopic excision of bronchogenic mediastinal cyst should be considered the primary therapeutic option.

Video-assisted thoracoscopic surgery of mediastinal bronchogenic cysts in adults: A single-center experience

Background Mediastinal bronchogenic cysts are rarely diagnosed in adults, hence surgical experience is limited particularly with regard to video-assisted thoracoscopic surgery. In support of the thoracoscopic approach we report our single-center experience in this rare entity. Methods Between June 1995 and December 2002, a nonselected series of 12 consecutive patients presenting with mediastinal bronchogenic cysts underwent video-assisted thoracoscopic surgery. Six cysts (50%) had been diagnosed 2 to 22 years prior, only three of which became symptomatic. In asymptomatic patients (n = 7) surgery was performed because of increasing cyst size (n = 3), patient's request (n = 3), or suspected metastasis (n = 1). Results Mediastinal bronchogenic cysts were correctly diagnosed by computed tomography in 83% (10/12) and by magnetic resonance imaging in 100% (9/9). Using a three-trocar technique thoracoscopic surgery was successfully performed in 11 of 12 cases (92%). We noted no signs of acute cyst infection. No serious postoperative complications were observed. In 1 patient conversion to open thoracotomy was necessary due to extensive pleural adhesions. In another case thoracoscopic excision of the cyst wall was incomplete. Patients with thoracoscopic excision were discharged after a median of 5.5 days (range 4 to 14 days). No recurrences or complications were observed during a mean follow-up of 40.5 months. Conclusions Considering the low conversion and complication rate in our series, video-assisted thoracoscopic surgery should be the primary therapeutic choice among adults with symptomatic mediastinal bronchogenic cysts. Surgical intervention in patients with asymptomatic and uncomplicated cysts appears optional.

Intrapulmonary bronchogenic cyst: CT and pathologic findings in five adult patients.

The purpose of our study was to describe the CT and pathologic findings of intrapulmonary bronchogenic cysts in five adult patients. Intrapulmonary bronchogenic cysts in adults appear on CT as well-defined ovoid lesions with the attenuation of soft tissue or water, similar to their mediastinal counterparts. Associated with these cysts are areas of mosaic low attenuation and bandlike linear attenuation representing histopathologically confirmed emphysema and bronchiolization or fibrotic change or both in the surrounding lung.

Bronchogenic Cysts in Adults: CT, MR, and Pathologic Findings

Bronchogenic Cysts in Adults: CT, MR, and Pathologic Findings