Pediatric Bronchogenic Cyst Clinical Presentation
- Author: Mary E Cataletto, MD; Chief Editor: Michael R Bye, MD more...
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.
- 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. 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.
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.
See the list below:
- Cysts are believed to result from abnormal development of the ventral foregut and lung budding during the first trimester.
Wright CD. Mediastinal tumors and cysts in the pediatric population. Thorac Surg Clin. 2009 Feb. 19(1):47-61, vi. [Medline].
Shanti CM, Klein MD. Cystic lung disease. Semin Pediatr Surg. 2008 Feb. 17(1):2-8. [Medline].
Stewart, B, Cochran, A, Iglesia, K, et al. Unusual case of stridor and wheeze in an infant. Pediatr Pulmonol. 2001. 34:320-3.
Correia-Pinto, J, Gonzaga, S, Huang, Y, et al. Congential Lung Lesions – underlying molecular mechanisms. Semin Ped Surg. 2010. 19:171-179.
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].
Ribet ME, Copin MC, Gosselin B. Bronchogenic cysts of the mediastinum. J Thorac Cardiovasc Surg. 1995 May. 109(5):1003-10. [Medline].
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].
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].
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].
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].
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].