Role of endobronchial ultrasound in the diagnosis and management of bronchogenic cysts: two case descriptions and literature review

Abstract

Imaging studies, such as high resolution computerized tomography (HRCT) and magnetic resonance imaging (MRI) facilitate the evaluation of mediastinal masses. However, the definite characterization of such masses can be ascertained only after tissue sampling is obtained and analyzed. Some mediastinal masses, like bronchogenic cysts, can be misdiagnosed as solid masses or lymphadenopathy in imaging studies, due to the variable densities of the cyst contents. More invasive tests, like fine needle aspiration or surgical resection of the bronchogenic cyst, may be necessary when HRCT fails to provide an initial diagnosis. We describe two such cases seen at our institution that highlight the implications of establishing a diagnosis of bronchogenic cyst with endobronchial ultrasound (EBUS)-trans-bronchial needle aspiration (TBNA) and discuss the possible therapeutic utility of EBUS-TBNA in select patients with bronchogenic cysts.

Role of endobronchial ultrasound scan in the diagnosis and management of intrapulmonary bronchogenic cyst misdiagnosed by low-dose CT scan of the chest as lung mass

“…CT scan of the chest usually shows fluid in the cyst with zero density (Hounsfield units), but in some cases density could be higher making the diagnosis more challenging 2 3. In our case, fluid density was 20, which favoured other differential diagnosis.…”

A 44-Year-Old Man With Nonproductive Cough and Sensation of Heaviness Over the Upper Chest

“…Cyst wall thickening, septations within the cyst, and hyperechoic shadows within the cyst may help to identify infection as well as complex cysts. 4,7,8 In this patient, the complete anechoic appearance of the cyst on EBUS favored a noninfective etiology. Real-time visualized SVC dilatation with progressive aspiration of the cyst (Discussion Video, Narration Video) associated with postprocedure relief of symptom favored SVC narrowing as the cause for clinical presentation in the study patient.…”

The role and safety of endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and management of infected bronchogenic mediastinal cysts in adults

“…The EBUS commonly shows the BC as anechoic or hypoechoic well defined structure without color flow signal and differentiates it from tumors or vascular abnormalities. It can also show septations, the presence of hyperechoic thickening within the cyst walls in case of complications [ 13 , 14 ]. It can also examine the echogenicity of the fluid similar to pleural fluids and help assess if it is a source of infection depending on the fluid characteristics [ 15 ].…”