Bronchogenic cyst
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Overview
While bronchogenic cysts are the most common cystic lesion of the mediastinum, their overall incidence is rare.
Pathophysiology and etiology
Bronchogenic cysts originate from anomalous development of the ventral foregut and can be found throughout the tracheoesophageal distribution including perihilar or intraparenchymal areas. they are usually single but may be multiple.
The most common location to find the anomaly is in the carina. The rarest locations include the interatrial septum, neck, abdomen, and retroperitoneal space.
If the cyst compresses a vital respiratory or cardiac structure, it can be symptomatic and life threatening.
Diagnosis
Symptoms
The majority of cases are asymptomatic, but some infants can present with respiratory distress, particularly if the cysts is located near the carina.
Chest X ray
The cyst may be identified on a routine chest x ray.
Pathological Findings
Images shown below are courtesy of Professor Peter Anderson DVM PhD and published with permission. © PEIR, University of Alabama at Birmingham, Department of Pathology
 Lower Respiratory Tract: Bronchogenic cysts are grossly nondescript, usually unilocular cavities containing mucus or mucopurulent material with a wall that varies in thickness and may contain cartilage. |
 Lower Respiratory Tract: Bronchogenic cysts are grossly nondescript, usually unilocular cavities containing mucus or mucopurulent material with a wall that varies in thickness and may contain cartilage. |
 Lower Respiratory Tract: Intrathoracic bronchogenic cyst; Histologically, smooth muscle bundles, minor salivary gland type tissue, and cartilage can be seen in the wall of the cyst. |
 Lower Respiratory Tract: Intrathoracic bronchogenic cyst; The lining is typically pseudostratified ciliated columnar epithelium which may show foci of squamous metaplasia at sites of inflammation (arrow). |
 Lower Respiratory Tract: Bronchogenic cyst; There is a cyst lined by bronchiolar epithelium and thick fascicles of smooth muscle in the wall. Islands of cartilage and submucosal salivary glands are lacking and the designation "foregut cyst consistent with bronchogenic cyst" might be more appropriate. |
 Lower Respiratory Tract: Bronchogenic cyst; There is a cyst lined by bronchiolar epithelium and thick fascicles of smooth muscle in the wall. Islands of cartilage and submucosal salivary glands are lacking and the designation "foregut cyst consistent with bronchogenic cyst" might be more appropriate. |
 Lower Respiratory Tract: Bronchogenic cyst; There is a multiloculated cyst lined by bronchiolar epithelium. A small island of cartilage is present at the upper right. |
 Heart-Great Vessels: Bronchogenic cyst; This example was removed from the epicardial surface of a 13-year-old. |
 Heart-Great Vessels: Bronchogenic cyst; The lining cells are cuboidal, and the cysts are surrounded by muscle and may contain underlying seromucous glands. |
 Mediastinum: Bronchogenic cyst; A thin-walled cyst which was present in the posterior mediastinum is distended with slightly cloudy somewhat mucinous fluid. |
 Mediastinum: Bronchogenic cyst; The inner surface is smooth and trabeculated in areas. |
 Mediastinum: Bronchogenic cyst; The cyst is lined by pseudostratified ciliated columnar epithelial cells and the wall contains accessory glands, layers of smooth muscle, and cartilage. |
 Mediastinum: Bronchogenic cyst; The cyst is lined by pseudostratified ciliated columnar epithelial cells and the wall contains accessory glands, layers of smooth muscle, and cartilage. |
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
