Mediastinal Bronchogenic Cyst Research Articles

Mediastinal Bronchogenic Cysts: Clinical Presentation, Diagnosis, and Treatment Outcomes

Mediastinal Bronchogenic Cysts: Clinical Presentation, Diagnosis, and Treatment Outcomes

Treatment of mediastinal bronchogenic cyst by rigid bronchoscopy and laser

Treatment of mediastinal bronchogenic cyst by rigid bronchoscopy and laser

Unusually severe neonatal presentation of mediastinal bronchogenic cyst.

Bronchogenic cysts are rare congenital malformations that occur in adults and children, with differences in distribution and presentation. We present the case of a newborn who initiated respiratory distress from the first minutes of life, presenting with hypoventilation and rightward displacement of the cardiac impulse, requiring oxygen therapy and intubation. The first radiograph shows a left pulmonary emphysema. The computerized axial tomography revealed a large mediastinal mass causing an obstructive syndrome of the left bronchus. The mass was successfully excised, resulting in a favorable clinical evolution. Although the presentation of our case is exceptional, it is worth noting that while most bronchogenic cysts are asymptomatic, they can occur in childhood, even from birth, as in our case.

Complete resection of a recurrent bronchogenic cyst tightly adhered to the left atrium using cardiopulmonary bypass: a case report

Abstract Background Most surgeons agree that symptomatic mediastinal bronchogenic cysts should be resected, and complete resection is considered mandatory to avoid recurrence. However, a symptomatic mediastinal bronchogenic cyst sometimes adheres to a vital organ, making complete resection hazardous. In such case, surgical resection using cardiopulmonary bypass should be performed to achieve complete resection. Case presentation A 65-year-old female patient had undergone surgical drainage of a mediastinal bronchogenic cyst 30 years ago. Recently, she presented with complaints of orthopnea, and computed tomography revealed a few days later a subcarinal bronchogenic cyst markedly compressing the left atrium. Complete resection of the mediastinal bronchogenic cyst was performed using cardiopulmonary bypass. The postoperative course was uneventful. The patient was followed up for 1 year, with no recurrence of the bronchogenic cyst. Conclusions For patients with mediastinal bronchogenic cysts compressing the left atrium, we recommend complete resection using cardiopulmonary bypass.

Thoracoscopic Excision of Mediastinal Bronchogenic Cysts in Children: A Case Series.

Background: Bronchogenic cysts result from a congenital anomalous budding of the tracheobronchial tree. Resection is usually recommended to avoid complications. Mediastinal bronchogenic cysts present a unique challenge due to their proximity to vital structures. The purpose of this study is to review our experience with mediastinal bronchogenic cysts. Methods: A single-institution retrospective review evaluated all mediastinal bronchogenic cyst excisions between January 2012 and November 2022. Patient demographics were assessed, including age at diagnosis, presenting symptoms, imaging workup, and cyst characteristics. Operative approach, complications, and surgical pathology were reported. Results: Five patients were identified. Age at diagnosis ranged from 18 to 27 months. No patient was diagnosed prenatally. All patients had symptoms at the time of diagnosis, including cough, wheezing, and respiratory distress. Three cysts were paratracheal, and two were paraesophageal. Age at surgery ranged from 26 to 30 months. All bronchogenic cysts were successfully resected thoracoscopically. Individual technical challenges included narrowing of the mainstem bronchus preventing lung isolation, significant mediastinal inflammation, the necessity for cyst evacuation to delineate the extent of the cyst, adherence of cyst wall to bronchus or trachea requiring cold dissection, and a stalk of tissue with an intimate connection to the carina that was amputated. No intraoperative or postoperative complication occurred. Surgical pathology was consistent with a bronchogenic cyst in all cases. Median length of hospital stay was two days. Conclusion: Thoracoscopy is a safe and effective procedure for mediastinal bronchogenic cyst excision in children. Certain technical maneuvers are highlighted, which may facilitate resection.

A Case of Mediastinal Bronchogenic Cyst Presenting with Hoarseness

A Case of Mediastinal Bronchogenic Cyst Presenting with Hoarseness

Thoracoscopic Excision of Technically Challenging Mediastinal Bronchogenic Cysts in Children

Thoracoscopic Excision of Technically Challenging Mediastinal Bronchogenic Cysts in Children

Role of esophageal ultrasound with a bronchoscope (EUS-B) with fine needle aspiration in the diagnosis of mediastinal Bronchogenic cyst.

A 12-year-old adolescent boy presented with complaints of persisting dry cough and exertional dyspnea. A CT chest revealed a cystic lesion posterior to the trachea and a flexible bronchoscopy revealed extrinsic compression of the posterior trachea and partial obstruction of the left main bronchus. He underwent an Endoscopic Ultrasound with a Bronchoscope. A Hypoechoic cystic lesion was seen just in front of the esophagus. Fine needle aspiration yielded thick mucoid aspirate and cytology revealed ciliated columnar epithelium, confirming the diagnosis of a Bronchogenic cyst.

Mediastinal Bronchogenic Cysts Resection in Adults: Results of Vats and Thoracotomy Procedures.

The objectives of our study are to evaluate our surgical experience of mediastinal bronchogenic cyst (MBC) and to determine the results of resection by video-assisted thoracic surgery (VATS) and posterolateral thoracotomy (PLT). The demographic characteristics, clinical and radiological features intraoperative data, outcomes and fol- low-up information were reviewed and analyzed from 38 patients who underwent resection of a MBC between 2008 and 2019. cystectomy was performed for thirty eight patients included in the present study. Seventeen of them, benefitedfrom VATS cystectomy (VATS group) with 1 conversion to thoracotomy (5.9%) and 21 underwent PLT cystectomy (PLT group). In our series 27 (71.1%) were male. Their average age was 42.6 years. While 09 patients (23.7%) had no symptoms pre-operatively, 29 patients (76.3%) were symptomatic. There were no operative deaths and 3 patients (7.9%) presented postoperative complications. The average duration ofhospital stay was 3.2 days for patients who had VATS, but 5.8 days for those who had thoracotomy. Long-term follow-up (range, 1 to 8 years) showed no late complications and no recurrence. VATS and PLT are main approaches for the surgical resection of MBCs VATS is a safe procedure, with less pain and time spent at the hospital. Early surgical procedures of MBCs may be recommended to prevent complications. Surgical adhesions are unfavorable conditions to thoracoscopic treatment.

Mediastinal bronchogenic cyst revealed by acute epigastralgia: a case report

Bronchogenic cyst (BC) occurs as an abnormality in the development of the primary foregut and may be mediastinal or pulmonary in the location. Most patients remain asymptomatic for several years. We report the observation of a young patient, presenting a symptomatic bronchogenic cyst revealed by acute epigastralgia, without other associated signs, he underwent a chest computed tomography (CT) scan showed a posterior mediastinal cystic formation and an oesogastric digestive endoscopy showed an aspect of extrinsic compression with an opposite mucosa which is normal. The patient was operated on urgently. The operative procedure consisted of partiel resection. The anapathological study of the surgical specimen confirmed the diagnosis. Through this presentation of this case, we try to underline the rarity of this symptomatology and its sudden installation. This is a case to sensitize gastroenterologist to think of a bronchogenic cyst in the acute abdominal pain and not to hesitate to ask for imaging.

Gastrointestinal: Beyond the gastrointestinal tract: Emergency endoscopic ultrasound-guided decompression of bronchogenic cyst as a bridge to surgery.

Bronchogenic cyst is a rare congenital malformation of the bronchial tree with a reported prevalence of 1 per 68 000 admissions in one hospital series. It is often found incidentally on cross-sectional imaging and rarely causes life-threatening compressive symptoms. We here present a case of massive mediastinal bronchogenic cyst requiring emergency endoscopic ultrasound (EUS)-guided decompression. A 22-year-old male patient presented with 1-week history of progressive breathlessness and chest pain. Urgent computed tomography thorax showed a 10-cm cystic lesion in the middle mediastinum compressing the left main bronchus and superior pulmonary vein causing heart failure and post obstructive pneumonia (Fig. 1). Patient was assessed by the anesthesia team and was deemed unfit to proceed to surgical removal of the cyst under general anesthesia due to compromised cardiopulmonary status. EUS-guided aspiration was performed under conscious sedation as a bridge to surgery. Midazolam and pethidine were titrated up gradually, and a total dose of 5 and 25 mg, respectively, were used. Procedure had to be performed at 30° prop up position with 3 L of oxygen supply via nasal cannula to avoid hypoxemia. Blood pressure was 128/63, pulse was 78, and oxygen saturation was 99% at the beginning of the procedure. Linear echoendoscope demonstrated a large anechoic well-defined 6.4 cm × 4 cm cystic structure between the esophagus, heart, and ascending aorta, compressing on the left atrium, ascending aorta, and pulmonary artery (Fig. 2). A 19-G needle was inserted into the cystic structure, and 140-mL viscous fluid was aspirated. The cyst immediately collapsed with relief of mass effect (Fig. 3). The procedure took 20 min to complete, and no infective or bleeding complications were reported. Follow-up computed tomography on Day 6 showed resolution of previous lung consolidative changes (Fig. 4). He underwent video-assisted thoracotomy and de-roofing of the mediastinal cyst 1 month later. This case has demonstrated that emergency EUS-guided aspiration of a bronchogenic cyst is a feasible and safe option particularly in patients who are hemodynamically unstable for traditional surgery under general anesthesia.

Huge mediastinal bronchogenic cyst revealed by hemoptysis and resected by uniportal VATS: A case report

Bronchogenic cysts are rare unusual congenital cysts, resulting from abnormal budding of the primary tracheobronchial tube and can be located either in the mediastinum or in the pulmonary parenchyma. They remain asymptomatic in most adults unless they are large to compress adjacent structures or infected. We report a case of a 43-year-old woman, who presented recurrent episodes of hemoptysis low abundance 4 months ago revealing a huge mediastinal cystic formation, initially taken as a hydatid cyst, the chest CT showed a voluminous cystic formation of 11,4x10, 9x8, 8 cm exerting a mass effect on the posterior mediastinal structures: the superior vena cava, the azygos vein, and the trachea. The diagnosis as a bronchogenic cyst is done after resected by uniportal video-assisted surgery (VATS), and histological confirmation. The patient does not present any complications or reoffending during the follow-up. The rarity of this entity and even more a rare association of this lesion with symptoms of hemoptysis led to the report of this case. This case illustrates the interest of uniportal VATS for the extirpation of the bronchogenic cyst. We recommend a complete exeresis in most cases to confirm the diagnosis, relieve symptoms, and prevent complications.

Extrapericardial bronchogenic cyst associated with atrial fibrillation

Bronchogenic cysts are rare and usually asymptomatic. There are very few reports of bronchogenic cysts producingatrial fibrillation in the literature. We present a rare case of atrial fibrillation as a complication of a mediastinal bronchogenic cyst. To our knowledge, there have been only 13 cases of atrial fibrillation caused by a bronchogenic cyst published in the literature. As demonstrated by prior studies, surgical resection has been a successful treatment of the atrial fibrillation in this population. Our case report presents additional evidence to support the effectiveness of surgical resection in the treatment of bronchogenic cyst induced atrial fibrillation.

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

Congenital lung overinflation secondary to a unilateral obstructing mediastinal bronchogenic cyst

We present the case of a 39 week-gestational age female infant who, following an uncomplicated pregnancy developed progressively worsening respiratory distress. She was diagnosed with a mediastinal bronchogenic cyst which was intermittently occluding the left mainstem bronchus, leading to overinflation of the left lung, mediastinal shift with the heart in the right chest and a hypoplastic right lung. Despite luminal stenting, the left lung remained enlarged with the right lung hypoinflated. Interestingly, there was no physiologic consequences to the significant mediastinal shift. We hypothesize that the process began in utero where the bronchogenic cyst caused unilateral bronchial occlusion triggering left lung hyperplasia. The cyst was resected without complication and the patient suffered no further respiratory issues.

Pilot Study of the Difference C-TBNA with EBUS-TBNA in Mediastinal Bronchial-Derived Cysts

Objective: To investigate the difference value of conventional transbronchial needle aspiration (C-TBNA) and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in mediastinal bronchogenic cysts. Method: A retrospective analysis of clinical data and follow-up data of 27 patients using conventional TBNA and EBUS-TBNA techniques diagnosed as mediastinal bronchogenic cysts from May 2008 to December 2016 in the First Affiliated Hospital of Soochow University was done. Results: In 8 years, there were 13 cases of C-TBNA and 14 cases of EBUS-TBNA-diagnosed mediastinal bronchogenic cysts. C-TBNA extracted clear liquid and its volume was 8.9 ± 1.5 ml. The 14 patients examined by EBUS had a homogenous anechoic signal. Clear liquid was extracted, and its volume was 29.1 ± 7.5 ml. The cyst liquid extracted with EBUS-TBNA was significantly more than that extracted with CTBNA (P < 0.05). During follow-up, 1 patient had cyst rupture after being punctured by C-TBNA, secondary pulmonary infection and right pleural effusion, followed by surgical treatment. The recurrence rate for C-TBNA was 100.00% (13/13), and that for EBUS-TBNA was 14.29% (2/14) (P < 0.05). Conclusion: The C-TBNA and EBUS-TBNA technologies have high diagnostic value for the mediastinal bronchogenic cysts. Both C-TBNA and EBUS-TBNA technologies have the risk of secondary infection and recurrence of cysts.

ENDOBRONCHIAL ULTRASOUND-GUIDED TRANSBRONCHIAL NEEDLE ASPIRATION OF A BRONCHOGENIC CYST

SESSION TITLE: Case Report Semifinalists 12 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Bronchogenic cysts are rare congenital malformations that can occur in various parts of the tracheobronchial tree and if symptomatic, can lead to a range of symptoms depending on location [1-2]. Historically, diagnostic confirmation and treatment was achieved via surgical means [1-2]; however, a growing body of evidence exists for the safety and efficacy of endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) of bronchogenic cysts [3]. CASE PRESENTATION: A 63-year-old female with a known asymptomatic non-FDG avid mediastinal lesion since 2008 presented for a chronic cough. She had previously presented with a right lower lobe pneumonia in early 2017.Physical exam was notable for an oxygen saturation of 97%, comfortably breathing ambient air with clear lung sounds bilaterally. Computed tomography (CT) imaging in late 2017 revealed significant interval increase in the mediastinal lesion which grew from 1.6x2.3cm to 3.0x2.5cm with associated luminal narrowing of the right bronchus intermedius. The mass was noted to be smoothly marginated, 30-40 Hounsfield units in density, and without associated lymphadenopathy or contrast enhancement, most consistent with an enteric duplication or other mediastinal cyst. Additionally, right lower lobe bronchiectasis and associated bronchial mucous plugging with air trapping was noted. The patient underwent flexible EBUS bronchoscopy. The bronchus intermedius was extrinsically obstructed by 75%. EBUS revealed a well demarcated hypoechoic fluid collection most consisted with a cyst. Transbronchial needle aspiration was performed removing 35mL of fluid. Complete resolution of bronchial luminal narrowing was achieved post-aspiration. The patient recovered without complications. Cystic fluid was sent for analysis. Microbiologic stains and cultures were negative. Cytology was notable for rare bland degenerative epithelial cells in a background of mucoid debris. No malignant cells were identified. DISCUSSION: Bronchogenic cysts are rare and may be associated with symptoms ranging from chronic cough to bronchial obstruction with recurrent infections [1-2]. CT imaging has known limitations in establishing the benign cystic characteristics of bronchogenic cysts [1]. They may be diagnosed and treated via surgical resection, which is invasive and has been associated with increased postoperative complications in symptomatic patients [1]. CONCLUSIONS: EBUS-TBNA is a safe and effective alternative to diagnosis and treatment of bronchogenic cysts. Reference #1: Patel SR, Meeker DP, Biscotti CV, et al. Presentation and management of bronchogenic cysts in the adult. Chest 1994;106(1):79-85. Reference #2: Liu HS, Li SQ, Cao ZL, et al. Clinical features and treatment of bronchogenic cyst in adults. Chin Med Sci J 2009;24(1):60-3. Reference #3: Maturu VN, Dhooria S, Agarwal R. Efficacy and Safety of transbronchial Needle Aspiration in Diagnosis and Treatment of Mediastinal Bronchogenic Cysts: Systematic Review of Case Reports. J Bronchology Interv Pulmonol 2015;22(3):195-203 DISCLOSURES: Speaker/Speaker's Bureau relationship with Boehringer-Ingelheim Please note: $5001 - $20000 Added 03/17/2019 by Jaime Betancourt, source=Web Response, value=Honoraria No relevant relationships by Adrian Mayo, source=Web Response No relevant relationships by Scott Oh, source=Web Response

The video-assisted thoracic surgery is the procedure of choice for the surgery of mediastinal bronchogenic cysts

Mediastinal bronchogenic cyst (MBC) is congenital, and a result of an abnormal budding of the primitive foregut. MBC is the most common mediastinal cyst, usually located along the tracheobronchial tree, most often found behind the carina (1). MBC can occur among all age group, from infants to adults. Bronchogenic cysts can occur intrapulmonary or extrapulmonary. If an abnormal budding occurs during early gestation, the bronchogenic cyst will usually be located in the mediastinum. MBCs rarely communicate with the tracheobronchial tree when compared to intrapulmonary bronchogenic cysts. MBCs are lined with respiratory ciliated columnar epithelium and filled with a whitish-gray mucinous material, which can change into pus with infection.

The Video-Assisted Thoracic Surgery for Mediastinal Bronchogenic Cysts: A Single-Center Experience.

The aim of this study was to evaluate the outcomes of video-assisted thoracic surgery (VATS) for mediastinal bronchogenic cyst (MBC) excision and investigate the surgical indication for MBC. We retrospectively reviewed all consecutive MBC patients who underwent surgical excision between April 2001 and June 2016. One hundred and nineteen patients were enrolled with a median age of 45.4years and divided into two groups: anterior mediastinum group (n = 48), and middle and posterior mediastinum group (n = 71). VATS technique was initially performed for each patient. The cyst should be resected completely as far as possible. Follow-up was completed by telephone or outpatient clinic every year. The deadline of follow-up was June 2017. One hundred and eighteen patients underwent VATS, and only one patient converted to open thoracotomy. The average operative time was 103.8 ± 41.6min (40-360min). The average intraoperative blood loss was 56.6 ± 86.6ml (5-600ml). The intraoperative complication rate was 3.4%, and the incomplete excision rate was 5.9%. The multivariate logistic analysis showed that maximal diameter >5cm was significantly associated with risk of operation time extension (OR = 3.968; 95% CI 1.179-13.355, p = 0.026) and bleeding loss increasing (OR = 12.242; 95% CI 2.420-61.933, p = 0.002). No serious postoperative complications were observed. Follow-up was performed in 102 patients, and the mean follow-up time was 45months (12-194months). There was no local recurrence. The maximal diameter >5cm increased risk of operation time extension and bleeding loss increasing. Early surgical excision of MBC by VATS is recommended to establish histopathological diagnosis, relieve symptoms, and prevent surgery-related complications.

An Unusual Cause of Airway Compromise in the Emergency Department: Mediastinal Bronchogenic Cyst

An Unusual Cause of Airway Compromise in the Emergency Department: Mediastinal Bronchogenic Cyst