Radiography
Bronchogenic cyst. Anteroposterior view on conventional radiograph demonstrates a mass in the aorto-pulmonary window.
Bronchogenic cyst. Lateral view on conventional radiograph demonstrates filling of the retrosternal clear space correlating to the abnormality observed on the frontal view.
Bronchogenic cyst. Conventional radiograph demonstrates a right paratracheal mass.
Bronchogenic cyst. Conventional radiograph demonstrates a subcarinal mass.
Bronchogenic cyst. Conventional radiograph demonstrates a subcarinal mass.
Bronchogenic cyst. Conventional radiograph demonstrates a thin-walled cyst in the left lower lobe with an air-fluid level.
Findings
Mediastinal cysts are visualized as a mediastinal mass on conventional radiographs. Intrapulmonary cysts usually present as a solitary pulmonary nodule unless the cyst contains air.
Degree of Confidence
On conventional radiographs, findings are nonspecific. Mediastinal masses should be evaluated further using CT or MRI to confirm the presence of fluid.
False Positives/Negatives
Difficulty is encountered in determining whether the visualized mass is benign (eg, a bronchogenic cyst) or malignant.
Computed Tomography
Bronchogenic cyst. Anteroposterior CT demonstrates a mass with fluid density.
Bronchogenic cyst. CT demonstrates a subcarinal mass with fluid density.
Bronchogenic cyst. CT demonstrates a thin-walled cyst in the right upper lobe.
Findings
Bronchogenic cysts are sharply marginated masses demonstrating water or soft-tissue density. Differences in attenuation result from the amount of proteinaceous fluid within the cysts. Cysts do not enhance after administration of IV contrast. An article from the Armed Forces Institute of Pathology documented the appearance of 62 cysts: 40% were water density, 40% were soft-tissue density, 5% contained milk of calcium, 10% were indeterminate from streak artifact, and the remainder were intrapulmonary, either completely air filled or containing an air-fluid level.7 In addition to intrapulmonary and mediastinal locations, bronchogenic cysts have been reported to be located in infradiaphragmatic areas, cutaneous areas, intrapericardial areas, and intramural areas of the esophagus.
Degree of Confidence
In the proper clinical setting, a CT finding of a sharply marginated, nonenhancing, water-density mass is diagnostic of a bronchogenic cyst. Nonenhancing masses demonstrating soft-tissue density need further evaluation using MRI. Location is also important. Intrapulmonary cysts are usually difficult to diagnose and usually require aspiration for diagnosis.
False Positives/Negatives
Most bronchogenic cysts are relatively characteristic in appearance on CT, but in atypical cases with hemorrhage or infection, findings may be confused with those of necrotic adenopathy, cystic lung disease, or lung abscess.
Magnetic Resonance Imaging
Bronchogenic cyst. Axial T2-weighted MRI demonstrates a high signal mass in the right paratracheal region.
Findings
Bronchogenic cysts are usually bright on T2-weighted images and dark on T1-weighted images. Cysts do not enhance after administration of IV gadolinium.
Degree of Confidence
On T2-weighted images, the brighter the cyst, the more confident the diagnosis of bronchogenic cyst. Lack of enhancement is also characteristic. Location is important in differentiating bronchogenic cysts from other cysts, such as pericardial cysts.
False Positives/Negatives
As with CT scans of typical bronchogenic cysts, MRI findings are very specific and few false-positive or false-negative findings occur. For atypical cysts, the main confusion is with necrotic tumors or infections.
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 Imaging: Bronchogenic Cyst |
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References
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Shah SK, Stayer SE, Hicks MJ, Brandt ML. Suprasternal bronchogenic cyst. J Pediatr Surg. Nov 2008;43(11):2115-7. [Medline].
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Teissier N, Elmaleh-Bergès M, Ferkdadji L, François M, Van den Abbeele T. Cervical bronchogenic cysts: usual and unusual clinical presentations. Arch Otolaryngol Head Neck Surg. Nov 2008;134(11):1165-9. [Medline].
Cardinale L, Ardissone F, Cataldi A, Gned D, Prato A, Solitro F, et al. Bronchogenic cysts in the adult: diagnostic criteria derived from the correct use of standard radiography and computed tomography. Radiol Med. Apr 2008;113(3):385-94. [Medline].
Ko SF, Hsieh MJ, Lin JW, Huang CC, Li CC, Cheung YC, et al. Bronchogenic cyst of the esophagus: clinical and imaging features of seven cases. Clin Imaging. Sep-Oct 2006;30(5):309-14. [Medline].
McAdams HP, Kirejczyk WM, Rosado-de-Christenson ML, et al. Bronchogenic cyst: imaging features with clinical and histopathologic correlation. Radiology. Nov 2000;217(2):441-6. [Medline]. [Full Text].
Bolton JW, Shahian DM. Asymptomatic bronchogenic cysts: what is the best management?. Ann Thorac Surg. Jun 1992;53(6):1134-7. [Medline].
Cioffi U, Bonavina L, De Simone M, et al. Presentation and surgical management of bronchogenic and esophageal duplication cysts in adults. Chest. Jun 1998;113(6):1492-6. [Medline].
Hutchin P. Congenital cystic disease of the lung. Rev Surg. Mar-Apr 1971;28(2):79-87. [Medline].
Naidich DP, Muller NL, Zerhouni EA. Mediastinal cysts. In: Computed Tomography and Magnetic Resonance of the Thorax. 3rd ed. Philadelphia, Pa: Lippincott-Raven;1999:125-7.
Rogers LF, Osmer JC. Bronchogenic cysts: a review of 46 cases. Am J Roentgenol AJR. 1964;91:273-83.
Keywords
bronchogenic cyst, foregut cyst, duplication cyst, congenital cyst
