Unusual presentation of a large tension bronchogenic cyst in an adult.

Abstract

A routine chest radiograph in a 20 year old man revealed a giant air filled cavity of the left hemithorax under tension. At thoracotomy a large left lower lobe intraparenchymal cyst required lobectomy and the pathological findings were consistent with a bronchogenic cyst. Although tension bronchogenic cysts are common in infants, this case demonstrates their unusual presentation in an adult. (Thorax 1993;48:951-952) Large air filled cysts displacing the mediastinum and causing respiratory distress have been reported frequently in infants.1-3 In contrast, giant bronchogenic cysts containing air under pressure have rarely been described in older children and adults.3 6We present an adult with this unusual complication who underwent successful surgical resection.Case report A 20 year old Haitian man who had been living in the USA for one year came to -the tuberculosis clinic for evaluation of a positive tuberculin test. A chest radiograph showed a large cystic lesion occupying most of the left hemithorax, displacing the trachea and the mediastinum to the right (fig 1). He

Bronchogenic cysts: clinicopathological presentation and treatment

“…Pathologically, it may be difficult to separate an acquired lesion from an intrapulmonary bronchogenic cyst, since an acquired cyst may occasionally epithelialize with pseudostratified ciliated epithelium. The absence of associated parenchymal and bronchial inflammation and the lack of a clinical history of pulmonary inflammation are suggestive of a bronchogenic cyst [30,31]. Although, in two patients, bronchogenic cysts were associated with other diseases, we believe this was coincidental, since the cysts were noninfected and uncomplicated, contained mucoid fluid, and did not communicate with the tracheobronchial tree.…”

“…MATZINGER et al [21] reported a case of intrapulmonary bronchogenic cyst in a 16 year old girl presenting with pneumothorax. Other reported complications are pleural effusion [22,23], arrhythmias [24], stenosis of the pulmonary artery [25], unilateral ventilation-perfusion defect [26], pericardial and cardiac tamponade [27], carcinomatous [28] or sarcomatous transformation [29], and giant tension bronchogenic cyst [30]. Intrapulmonary bronchogenic cysts generally present as one of three different patterns on the chest radiograph.…”

“…When communication is established with the bronchial tree, the cyst presents as airfilled or contains an air-fluid level. Such a cyst may be confused with lung abscesses, complicated hydatid cysts, infected bullae, cavities resulting from tuberculosis, fungal diseases, carcinoma, or infarctions [5,17,30,31]. Mediastinal bronchogenic cysts usually present as ovoid or round, well-defined masses of homogeneous water density on the chest radiograph [31,32].…”

Large Tension Bronchogenic Cyst in an Adult Mimicking the Swyer-James Syndrome

“…The symptoms caused by an intrapulmonary cyst depend on its location, size and the possibility of a communication with the bronchial tree. Respiratory distress caused by a tension bronchogenic cyst is observed almost entirely in infants [2,6,7]. An air-filled, tension bronchogenic cyst causing displacement of the adjacent structures and respiratory distress is a very rare entity in adults, and only a few documented cases have been reported [2,3,8].…”

“…Tension, air-filled bronchogenic cysts are a well-recognized cause of respiratory distress in infants. Very few cases of this type of complicated bronchogenic cysts have been reported in adults [1][2][3]. We describe the case of an adult patient with respiratory distress caused by a large tension bronchogenic cyst treated surgically.…”