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Pediatric Bronchogenic Cyst Clinical Presentation

  • Author: Mary E Cataletto, MD; Chief Editor: Michael R Bye, MD  more...
 
Updated: Nov 15, 2015
 

History

With the advent of improved antenatal diagnosis, many infants are identified prior to the development of symptoms.

  • Chest pain and dysphagia are the most common symptoms in adults with bronchogenic cysts.
  • Recurrent infections may be the clinical presentation in some children
  • In infants, symptoms are most often produced as a result of airway or esophageal compression.
  • Superior vena cava syndrome, tracheal compression, pneumothorax, pleurisy, and pneumonia were reported in a series of 30 adult patients.[8]
  • Intra-abdominal cysts are rare. As with the mediastinal variety, most are asymptomatic; however, hemorrhage, infection, and compression of adjacent structures can be observed.
  • The presence of symptoms is important in preoperative assessment because symptomatic patients are more likely to have perioperative difficulties.
  • In 1995, Ribet and colleagues reported that 70.8% of children were symptomatic because 75% of the cysts were in a critical area around the level of the carina.[6] Approximately 60% of adults in this series were symptomatic, and 53% of those mediastinal cysts were at or above the carina.
  • Limaiem et al (2008) reported 33 cases of bronchogenic cysts and identified 4 categories of presentation: asymptomatic 6%; general symptoms including anorexia, weight loss, and fever; respiratory symptoms including chest pain, hemoptysis, cough, and dyspnea; and other symptoms including dysphagia and back pain.[5]
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Physical

See the list below:

  • Location is more important than cyst volume in its association with symptoms of compression.
  • Signs of airway compression are more frequently observed in infants and small children than in adults and may include cough, wheeze, dyspnea, and respiratory distress.
  • Secondary infection of the cyst may occur and may present with fever and respiratory symptoms.
  • Gastric symptoms, including abdominal pain may be observed. Peptic ulceration may be identified in cysts containing gastric mucosa.
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Causes

See the list below:

  • Cysts are believed to result from abnormal development of the ventral foregut and lung budding during the first trimester.
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Contributor Information and Disclosures
Author

Mary E Cataletto, MD Professor of Clinical Pediatrics, State University of New York at Stony Brook

Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Charles Callahan, DO Professor, Chief, Department of Pediatrics and Pediatric Pulmonology, Tripler Army Medical Center

Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, Association of Military Surgeons of the US, Christian Medical and Dental Associations

Disclosure: Nothing to disclose.

Chief Editor

Michael R Bye, MD Professor of Clinical Pediatrics, State University of New York at Buffalo School of Medicine; Attending Physician, Pediatric Pulmonary Division, Women's and Children's Hospital of Buffalo

Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Additional Contributors

Girish D Sharma, MD, FCCP, FAAP Professor of Pediatrics, Rush Medical College; Director, Section of Pediatric Pulmonology and Rush Cystic Fibrosis Center, Rush Children's Hospital, Rush University Medical Center

Girish D Sharma, MD, FCCP, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, Royal College of Physicians of Ireland

Disclosure: Nothing to disclose.

References
  1. Wright CD. Mediastinal tumors and cysts in the pediatric population. Thorac Surg Clin. 2009 Feb. 19(1):47-61, vi. [Medline].

  2. Shanti CM, Klein MD. Cystic lung disease. Semin Pediatr Surg. 2008 Feb. 17(1):2-8. [Medline].

  3. Stewart, B, Cochran, A, Iglesia, K, et al. Unusual case of stridor and wheeze in an infant. Pediatr Pulmonol. 2001. 34:320-3.

  4. Correia-Pinto, J, Gonzaga, S, Huang, Y, et al. Congential Lung Lesions – underlying molecular mechanisms. Semin Ped Surg. 2010. 19:171-179.

  5. 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 Jan-Feb. 186(1):55-61. [Medline].

  6. Ribet ME, Copin MC, Gosselin B. Bronchogenic cysts of the mediastinum. J Thorac Cardiovasc Surg. 1995 May. 109(5):1003-10. [Medline].

  7. Maurin S, Hery G, Bourliere B, Potier A, Guys JM, Lagausie PD. Bronchogenic cyst: Clinical course from antenatal diagnosis to postnatal thoracoscopic resection. J Minim Access Surg. 2013 Jan. 9(1):25-8. [Medline].

  8. Aktogu S, Yuncu G, Halilçolar H, Ermete S, Buduneli T. Bronchogenic cysts: clinicopathological presentation and treatment. Eur Respir J. 1996 Oct. 9(10):2017-21. [Medline].

  9. Lee EY, Tracy DA, Mahmood SA, Weldon CB, Zurakowski D, Boiselle PM. Preoperative MDCT evaluation of congenital lung anomalies in children: comparison of axial, multiplanar, and 3D images. AJR Am J Roentgenol. 2011 May. 196(5):1040-6. [Medline].

  10. Jung HS, Kim DK, Lee GD, Sim HJ, Choi SH, Kim HR, et al. Video-assisted thoracic surgery for bronchogenic cysts: is this the surgical approach of choice?. Interact Cardiovasc Thorac Surg. 2014 Nov. 19 (5):824-9. [Medline].

  11. Jiang JH, Yen SL, Lee SY, Chuang JH. Differences in the distribution and presentation of bronchogenic cysts between adults and children. J Pediatr Surg. 2015 Mar. 50 (3):399-401. [Medline].

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Plain chest radiograph showing a left paraspinal mass. Photo courtesy of A Fruauff, MD.
Esophagogram shows an anterior and lateral mass effect in the distal portion of the esophagus corresponding to the paraspinal mass (see the radiographic image above). Photo courtesy of A Fruauff, MD.
Chest CT scan shows an increased soft tissue density in the left paraesophageal area. Photo courtesy of A Fruauff, MD.
The left side shows a low-power view of a bronchogenic cyst showing cartilage and smooth muscle within the wall and the cyst lined by ciliated columnar epithelium. The right side shows a high-power view (40X) of a bronchogenic cyst demonstrating the ciliated columnar epithelial lining. Photo courtesy of A Schuss, MD.
Extrapulmonary bronchogenic cyst. Unilocular cystic mass attached to mediastinal structures by a short pedicle. The inner surface is trabeculated, and the cyst contains mucinous material. The cyst measures 15 cm X 5 cm. Photo courtesy of K Kenigsberg, MD.
 
 
 
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