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Pediatric Bronchogenic Cyst Workup

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

Imaging Studies

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  • Prenatal studies: Bronchogenic cysts are prenatally identified in 70% of cases using high-resolution ultrasonography. Conventional 2-view chest radiography and barium swallow are often sufficient to support a preoperative diagnosis. Additional clarification may be obtained using chest CT and MRI studies. Ultrafast MRI provides additional anatomic detail. For prenatally identified lesions, chest CT scanning is recommended after birth regardless of the radiography findings at that time.
  • Conventional 2-view chest radiography
    • This is the first diagnostic study indicated in a child with respiratory distress.
    • This typically shows a sharply demarcated spherical mass of variable size, most commonly located in the middle mediastinum around the carina, as shown below.
      Plain chest radiograph showing a left paraspinal mPlain chest radiograph showing a left paraspinal mass. Photo courtesy of A Fruauff, MD.
    • When the cyst is infected or contains secretions, it may appear as a solid tumor or may demonstrate an air fluid level.
  • Esophagography: A barium swallow helps to define the mass and its effect on adjacent structures (see the image below).
    Esophagogram shows an anterior and lateral mass efEsophagogram 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: Cysts appear as lesions with smooth borders and thin walls and may contain secretions, pus, or blood. Calcifications may also be observed.
  • CT or MRI
    • A homogeneous mass of moderate-to-bright intensity is observed on T2-weighted MRI.
    • On T1-weighted images, lesions may vary in their intensity because of their protein content.
    • The finding of a cystic lesion at the level of the carina on CT scan or MRI is most frequently associated with a bronchogenic cyst.
    • In all other locations, diagnosis cannot be as reliably forecast.
    • A study of preoperative MDCT concluded that axial MDCT images accurately diagnose the types, location, associated mass effect, and anomalous arteries of congenital lung anomalies.[9]
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Procedures

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  • Limaiem et al (2008) reported the results of 23 patients with bronchogenic cysts who underwent bronchoscopic evaluation.[5] They demonstrated evidence of extrinsic compression of the tracheobronchial tree in 4 cases and identified a fistula in 8 cases.
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Histologic Findings

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  • Surgical specimens of excised bronchogenic cysts reveal cystic lesions lined by respiratory epithelium.
  • Occasionally, cysts may contain gastric mucosa or bronchial cartilage.
  • Differentiation between congenital and acquired cysts may be difficult, if not impossible, in the presence of coexisting infection.
  • The image below shows the surgical pathology of a cystic lesion. The left side is a low-power view of a bronchogenic cyst showing cartilage and smooth muscle within the wall and cyst lined by ciliated columnar epithelium. The right side is a high-power view (40X) of the same slide, showing ciliated columnar epithelial lining of the cyst.
    The left side shows a low-power view of a bronchogThe 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.
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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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