Bronchogenic cyst: Difference between revisions
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CT scan may be helpful in the diagnosis of bronchogenic cyst. Findings on CT scan suggestive of bronchogenic cyst is an | CT scan may be helpful in the diagnosis of bronchogenic cyst. Findings on CT scan suggestive of bronchogenic cyst is an | ||
*[[cyst|Cysic mass]] with air-fluid levels<ref name="pmid23013612">{{cite journal| author=Wang W, Ni Y, Zhang L, Li X, Ke C, Lu Q | display-authors=etal| title=A case report of para-esophageal bronchogenic cyst with esophageal communication. | journal=J Cardiothorac Surg | year= 2012 | volume= 7 | issue= | pages= 94 | pmid=23013612 | doi=10.1186/1749-8090-7-94 | pmc=3599576 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23013612 }} </ref> | |||
*ovoid and well-defined encapsulated low-density cystic mass with no contrast enhancement.<ref name="pmid19015445">{{cite journal| author=Teissier N, Elmaleh-Bergès M, Ferkdadji L, François M, Van den Abbeele T| title=Cervical bronchogenic cysts: usual and unusual clinical presentations. | journal=Arch Otolaryngol Head Neck Surg | year= 2008 | volume= 134 | issue= 11 | pages= 1165-9 | pmid=19015445 | doi=10.1001/archotol.134.11.1165 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19015445 }} </ref><ref name="pmid26986156">{{cite journal| author=Han C, Lin R, Yu J, Zhang Q, Zhang Y, Liu J | display-authors=etal| title=A Case Report of Esophageal Bronchogenic Cyst and Review of the Literature With an Emphasis on Endoscopic Ultrasonography Appearance. | journal=Medicine (Baltimore) | year= 2016 | volume= 95 | issue= 11 | pages= e3111 | pmid=26986156 | doi=10.1097/MD.0000000000003111 | pmc=4839937 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26986156 }} </ref> | *ovoid and well-defined encapsulated low-density cystic mass with no contrast enhancement.<ref name="pmid19015445">{{cite journal| author=Teissier N, Elmaleh-Bergès M, Ferkdadji L, François M, Van den Abbeele T| title=Cervical bronchogenic cysts: usual and unusual clinical presentations. | journal=Arch Otolaryngol Head Neck Surg | year= 2008 | volume= 134 | issue= 11 | pages= 1165-9 | pmid=19015445 | doi=10.1001/archotol.134.11.1165 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19015445 }} </ref><ref name="pmid26986156">{{cite journal| author=Han C, Lin R, Yu J, Zhang Q, Zhang Y, Liu J | display-authors=etal| title=A Case Report of Esophageal Bronchogenic Cyst and Review of the Literature With an Emphasis on Endoscopic Ultrasonography Appearance. | journal=Medicine (Baltimore) | year= 2016 | volume= 95 | issue= 11 | pages= e3111 | pmid=26986156 | doi=10.1097/MD.0000000000003111 | pmc=4839937 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26986156 }} </ref> | ||
*Thin subtle walls | *Thin subtle walls |
Revision as of 22:25, 8 July 2020
Bronchogenic cyst | |
DiseasesDB | 1707 |
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MeSH | D009404 |
Bronchogenic cyst Microchapters |
Diagnosis |
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Treatment |
Case Studies |
Bronchogenic cyst On the Web |
American Roentgen Ray Society Images of Bronchogenic cyst |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor: Cafer Zorkun, M.D., Ph.D. [2]
Synonyms and keywords: Bronchial cyst
Overview
Bronchogenic cyst is a benign congenital malformation of the tracheobronchial tree derived from the ventral aspect of the foregut. It most frequently occurs in the middle mediastinum, in the early stages of gestation or in the lungs, at the later stages of gestation. Atypical locations may be explained by its embryologic origin. Patients with bronchogenic cyst may be asymptomatic or present with respiratory distress, increasing stridor, feeding difficulties, chest pain, cough, progressive dysphagia, odynophagia, purulent sputum, dyspnea, anorexia and/orweight loss. Radiologic findings are useful to differentiate bronchogenic cysts from other cysts but may they not always confirm the diagnosis. Diagnosis is confirmed by surgical excision, which is curative, and histological findings of ciliated columnar epithelial lining of the cyst.
Historical Perspective
There is limited information about the historical perspective of bronchogenic cyst.
Classification
Bronchogenic cyst can be classified based on location as follows[1][2]
1. Pulmonary
A. Plural
i. Visceral
ii. Parietal
i. Paratracheal
ii. Carinal
iii. Hilar
2. Extra-pulmonary
A. Cranial
C. Mediastinal
ii. Retroperitoneal
E. Perianal
Bronchogenic cyst | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pulmonary | Extra-pulmonary | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Plural | Tracheobronchial tree | Cranial | Cervical | Mediastinal | Abdominal | Perianal | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Visceral | Parietal | Paratracheal | Carinal | Hilar | esophageal | Cardiac | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Intraperitoneal | Retroperitoneal | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Diphragmatic | Gastric | Hepatic | Spinal | Adrenal | Pancreatic | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Paraspinal | Intraspinal | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Pathophysiology
It is thought that bronchogenic cyst is the result of abnormal budding of the ventral [6] portion of the primitive foregut[1][2][3]destined to become the tracheobronchial tree[7] between days 26 - 40 of gestation. [7] At such, it is always found in relation to the trachea or esophagus.[8] If the cell mass maintains its connection with the tracheobronchial tree, the cyst becomes intrapulmonary or in close association with the lungs. If separated, there is no contiunity with the bronchia lumen. Such cyst increases in size gradually due to secretions produced within the cavity, leading to compressive symptoms.[1][9]
Gross pathology
Bronchogenic cyst appear as single or multiple smooth spherical pink masses which may be unlobulated or lobulated. [7][1] The lobules could be of various sizes, communicating or noncommunicating. The wall is relatively thin and frequently trabeculated,[1] even though there may be thicker portions. It is lined by clilated columnar epithelium which secretes a thick, white mucoid material if uninfected, and a dirty brown mucoid to purulent material if infected.[1] Occassionally, secretions could be hemorrhagic or pneumatic.[2]
Histopathology
Bronchogenic cysts are usually lined by ciliated columnar epithelium of respiratory type, leading to distention as a result of secretions produced within the cavity. Cyst wall may be composed of cartilage, smooth muscle, fibrous tissue, chronic inflammatory infiltrates, necrotic tissue, focal areas of squamous metaplasia, vascular proliferation, bronchial gland, and mucous glands.[7] [1] [10] [3][11]
Causes
The cause of bronchogenic cysts is undetermined.
Differentiating Bronchogenic cyst from other Diseases
Bronchogenic cyst must be differentiated from lung abcess, thymic cyst, and esophageal duplication cysts
Diseases | Clinical manifestations | Para-clinical findings | Gold standard | Additional findings | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Symptoms | Physical examination | ||||||||||||||
Lab Findings | Imaging | Histopathology | |||||||||||||
Symptom 1 | Symptom 2 | Symptom 3 | Physical exam 1 | Physical exam 2 | Physical exam 3 | Lab 1 | Lab 2 | Lab 3 | Imaging 1 | Imaging 2 | Imaging 3 | ||||
Differential Diagnosis 1 | |||||||||||||||
Differential Diagnosis 2 | |||||||||||||||
Differential Diagnosis 3 |
Epidemiology and Demographics
Incidence
- Bronchogenic cyst accounts for 10% to 15% of mediastinal tumors and 50 to 60% of all mediastinal cysts.[12]
Prevalences
- The prevalence of bronchogenic cyst is estimated at 1 per 42,000 and 1 per 68,000 admissions in two hospital series.[13]
Case fatality rate/mortality rate
- In 2011, broncogenic cyst was shown to have a case-fatality rate/mortality rate of 20%.[14]
Age
- Bronchogenic cyst can be found in people of all age groups.[15]
Race
- There is no racial predilection to bronchogenic cyst.
Gender
- Bronchogenic cyst is slightly more prevalent in men and often remain undetected till the third or fourth decade of life.[16][11]
Risk Factors
There are no established risk factors for bronchogenic cyst.
Screening
There is insufficient evidence to recommend routine screening for bronchogenic cyst as it is usually an incidental finding.
Natural History, Complications and Prognosis
Natural History
The symptoms of bronchogenic cyst usually develop in the third to fourth decade of life and start with symptoms such as
- Dyspnea[2]
- Chronic dry cough[2]
- Chest discomfort/pain[2]
- Flu-like symptoms
- Fever[2]
- Purulent sputum[2]
- Abdominal discomfort
- Limb weakness
Complication
Common complications of bronchogenic cyst include
- Tracheal compression[15][11]
- Esophageal compression[2]
- Cough[15]
- Infection[15][3]
- Hemoptysis[15]
- Superior vena cava syndrome[11]
- Pneumothorax[11]
- Pleurisy[11]
- Pneumonia[11]
- Lymphangioma[3]
- Haemorrhage[3]
- Neoplasia(adenocarcinoma, mucoepidermoid carcinoma, anaplastic carcinoma, and leiomyosarcoma)[3][5][6][17]
- Rupture[2][5]
Prognosis
Prognosis is generally good,[3] a Morbidity & Mortality rate of 20% has been recorded in older patients treated for bronchogenic cyst.[14]
Diagnosis
The majority of patients with bronchogenic cyst are asymptomatic and are diagnosed during investigation for other pathologies.[1][17]
When symptomatic, clinical presentation of bronchogenic cyst depends on the age of the patient, size and the location of the cyst.[1]
In infants bronchogenic cyst presents with [3][15]
- respiratory distress
- Increasing stridor
- Feeding difficulties.
In children and adults, bronchogenic cyst presents with
- Dull chest pain[1][2]
- Dry cough,[6]
- Progressive dysphagia[1]
- Odynophagia[6]
- wheezing[1]
- Fever[2]
- purulent sputum[1]
- Hemoptysis[2]
- Dyspnea[5]
- Anorexia and/or weight loss[11]
- Physical examination of patients with bronchogenic cyst is usually normal.
- Some patients with bronchogenic cyst may have elevated serum tumor marker CA125 and CA199, which is usually suggestive of progression/complication.[6]
Despite enhanced imaging modalities, a definitive diagnosis is challenging preoperatively.[6]
An x-ray with esophagography may be helpful in the diagnosis of bronchogenic cyst. Findings on an x-ray suggestive of bronchogenic cyst include:[15][2]
- Well-defined anterior mediastinal mass with incomplete peripheral thin linear calcification.
- Homogeneous non-calcified soft tissue density mass.
- Round to oval opacity
- Secondary excavation
- Cavity with or without levels
- Atelectasis
- Hydropneumothorax
CT scan may be helpful in the diagnosis of bronchogenic cyst. Findings on CT scan suggestive of bronchogenic cyst is an
- Cysic mass with air-fluid levels[4]
- ovoid and well-defined encapsulated low-density cystic mass with no contrast enhancement.[3][6]
- Thin subtle walls
The density of bronchogenic cysts is variable from water density to high density due to blood, anthracotic pigment, increased calcium content, or increased protein content of the fluid.[12][18]
- MRI may be helpful in the diagnosis of bronchogenic cyst. Findings on MRI suggestive of bronchogenic cyst include
- T1-weighted images show ipointense signal
- T2-weighted images show hyperintense signal.
After contrast injection, enhancement of the cyst is frequently absent.[6][12][18]
- Ultrasound may be helpful in the diagnosis of bronchogenic cyst. Finding on an ultrasound suggestive of bronchogenic cyst is a hyperechoic fluid filled solid mass.[3][6]
Other diagnostic studies for bronchogenic cyst include:
- Excision and Hematoxylin and Eosin staining,[5] which demonstrates cillated columar epithelia cells.[6][17]
- Immunohistochemical stainingof bronchogenic cyst of esophagus , whcich demonstartes a positive expression of CA199 and CA125.[6]
- Bronchoscopy, which demonstrates pink cystic mass with bronchial attachment[2]
- Gastroendoscopy and endoscopic ultrasonography, which demonstartes abdominal anatomic relations.[6]
Treatment
Surgery is the mainstay of treatment for bronchogenic cyst even when the patients are asymptomatic,[17]conservative approach is not approved.[11] Surgery is imperative with symptoms such as [2]
- Dyspnea
- Dysphagia
- Pain
- Purulent sputum
- Hemoptysis
Most commonly used approaches for complete excision of bronchogenic cysts are[6][17]
Other procedures include
- Endoscopic submucosal tunnel dissection[17][6]
- Percutaneous catheter drainage or endoscopic ultrasonographic guided-fine needle aspiration[6] with sterile alcohol ablation has been used in selected high-risk patients, especially adults, but has no place in pediatric therapeutics.[3]
- video-assisted thorascopic surgery[6]
- Robotic resection
Complete surgical resection is curative.[3] Risk during surgery is usually low, complications include but are not limited to persistent air leak,[2] pulmonary and vascular compressions, vascular, pleural, tracheobronchial, pulmonary, mediastinal and diaphragmatic adhesions.[11]
Case Studies
Template:WikiDoc Sources
CME Category::Cardiology
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 Maier HC (1948). "Bronchiogenic Cysts of the Mediastinum". Ann Surg. 127 (3): 476–502. doi:10.1097/00000658-194803000-00010. PMC 1513836. PMID 17859095.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 2.19 Sarper A, Ayten A, Golbasi I, Demircan A, Isin E (2003). "Bronchogenic cyst". Tex Heart Inst J. 30 (2): 105–8. PMC 161894. PMID 12809250.
- ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 Teissier N, Elmaleh-Bergès M, Ferkdadji L, François M, Van den Abbeele T (2008). "Cervical bronchogenic cysts: usual and unusual clinical presentations". Arch Otolaryngol Head Neck Surg. 134 (11): 1165–9. doi:10.1001/archotol.134.11.1165. PMID 19015445.
- ↑ 4.0 4.1 Wang W, Ni Y, Zhang L, Li X, Ke C, Lu Q; et al. (2012). "A case report of para-esophageal bronchogenic cyst with esophageal communication". J Cardiothorac Surg. 7: 94. doi:10.1186/1749-8090-7-94. PMC 3599576. PMID 23013612.
- ↑ 5.0 5.1 5.2 5.3 5.4 Chuang KH, Huang TW, Cheng YL, Chen JC, Tzao C, Chang H; et al. (2007). "Esophageal bronchogenic cyst: a rare entity". Z Gastroenterol. 45 (9): 958–60. doi:10.1055/s-2007-963069. PMID 17874358.
- ↑ 6.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.09 6.10 6.11 6.12 6.13 6.14 6.15 Han C, Lin R, Yu J, Zhang Q, Zhang Y, Liu J; et al. (2016). "A Case Report of Esophageal Bronchogenic Cyst and Review of the Literature With an Emphasis on Endoscopic Ultrasonography Appearance". Medicine (Baltimore). 95 (11): e3111. doi:10.1097/MD.0000000000003111. PMC 4839937. PMID 26986156.
- ↑ 7.0 7.1 7.2 7.3 "StatPearls". 2020. PMID 30725658.
- ↑ Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID https://doi.org/10.1186/1749-8090-7-94 Check
|pmid=
value (help). - ↑ Suda K, Sueyoshi R, Okawada M, Koga H, Lane GJ, Yamataka A; et al. (2015). "Completely intramural bronchogenic cyst of the cervical esophagus in a neonate". Pediatr Surg Int. 31 (7): 683–7. doi:10.1007/s00383-015-3720-1. PMID 26002606.
- ↑ Mehta RP, Faquin WC, Cunningham MJ (2004). "Cervical bronchogenic cysts: a consideration in the differential diagnosis of pediatric cervical cystic masses". Int J Pediatr Otorhinolaryngol. 68 (5): 563–8. doi:10.1016/j.ijporl.2003.12.015. PMID 15081229.
- ↑ 11.0 11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8 11.9 Aktoğu S, Yuncu G, Halilçolar H, Ermete S, Buduneli T (1996). "Bronchogenic cysts: clinicopathological presentation and treatment". Eur Respir J. 9 (10): 2017–21. doi:10.1183/09031936.96.09102017. PMID 8902460.
- ↑ 12.0 12.1 12.2 McAdams HP, Kirejczyk WM, Rosado-de-Christenson ML, Matsumoto S (2000). "Bronchogenic cyst: imaging features with clinical and histopathologic correlation". Radiology. 217 (2): 441–6. doi:10.1148/radiology.217.2.r00nv19441. PMID 11058643.
- ↑ Limaïem F, Ayadi-Kaddour A, Djilani H, Kilani T, El Mezni F (2008). "Pulmonary and mediastinal bronchogenic cysts: a clinicopathologic study of 33 cases". Lung. 186 (1): 55–61. doi:10.1007/s00408-007-9056-4. PMID 18064522.
- ↑ 14.0 14.1 Makhija Z, Moir CR, Allen MS, Cassivi SD, Deschamps C, Nichols FC; et al. (2011). "Surgical management of congenital cystic lung malformations in older patients". Ann Thorac Surg. 91 (5): 1568–73, discussion 1573. doi:10.1016/j.athoracsur.2011.01.080. PMID 21420068.
- ↑ 15.0 15.1 15.2 15.3 15.4 15.5 15.6 Ribet ME, Copin MC, Gosselin BH (1996). "Bronchogenic cysts of the lung". Ann Thorac Surg. 61 (6): 1636–40. doi:10.1016/0003-4975(96)00172-5. PMID 8651761.
- ↑ Lardinois D, Gugger M, Ris HB (1999). "Bronchogenic cyst of the left lower lobe associated with severe hemoptysis". Eur J Cardiothorac Surg. 16 (3): 382–3. doi:10.1016/s1010-7940(99)00226-2. PMID 10554866.
- ↑ 17.0 17.1 17.2 17.3 17.4 17.5 Yang X, Zong Y, Zhao HY, Wu YD, Ji M (2019). "Complete excision of esophageal bronchogenic cyst by endoscopic submucosal tunnel dissection: a case presentation". BMC Gastroenterol. 19 (1): 155. doi:10.1186/s12876-019-1072-3. PMC 6714396 Check
|pmc=
value (help). PMID 31462259. - ↑ 18.0 18.1 Chen TJ, Liao CH, Shen TC (2018). "Bronchogenic cyst". QJM. 111 (12): 905. doi:10.1093/qjmed/hcy140. PMID 29939368.