Introduction
Bronchogenic cyst. Anteroposterior view on conventional radiograph demonstrates a mass in the aorto-pulmonary window.
Bronchogenic cyst. Anteroposterior CT demonstrates a mass with fluid density.
Bronchogenic cyst. Axial T2-weighted MRI demonstrates a high signal mass in the right paratracheal region.
Background
Bronchogenic cysts are congenital in nature. They are part of a spectrum of congenital abnormalities of the lung, including pulmonary sequestration, congenital cystic adenomatoid malformation, and congenital lobar hyperinflation (emphysema).1,2,3
Related eMedicine topics:
Bronchogenic Cyst (Pediatrics: General Medicine)
Pulmonary Sequestration (Radiology)
Pulmonary Sequestration (Pediatrics: General Medicine)
Congenital Cystic Adenomatoid Malformation
Emphysema
Frequency
United States
The frequency of bronchogenic cysts is unknown, presumably because most patients are asymptomatic. Numerous studies have documented the rare incidence of bronchogenic cysts, with the average incidence being 20 cases over a 20-year period.
International
International frequency is unknown.
Mortality/Morbidity
Although bronchogenic cysts are usually an incidental finding, morbidity associated with bronchogenic cysts has been reported as occurring because the cyst becomes secondarily infected or because postobstructive pneumonia occurs. Dysphagia and dyspnea have resulted from compression of a large cyst on the esophagus and airways. Cases have been reported of cyst rupture and hemorrhage within the cyst.
Race
The frequency in different races is unknown.
Sex
Frequency in each sex is unknown.
Age
Bronchogenic cysts are congenital lesions. Large cysts may present in the pediatric population because of compression of the esophagus or trachea or because of infection. In adults, the cysts typically present as an incidental mass in either the mediastinum or the lung.
Presentation
Natural history and presentation
Bronchogenic cysts are located most commonly in the mediastinum (85%). Other common locations include subcarinal, paratracheal, and retrocardiac sites. Intrapulmonary bronchogenic cysts are less common (15%).
Histologically, cysts are thin walled, filled with mucoid material, and lined with columnar respiratory epithelium, mucous glands, cartilage, elastic tissue, and smooth muscle. Bronchogenic cysts develop from an abnormal budding of the ventral foregut between the 26th and 40th week of gestation. As such, they are often more appropriately termed foregut duplication cysts.
In the pediatric population, bronchogenic cysts present as fever or difficultly breathing. Adults with bronchogenic cysts are usually asymptomatic. Patients with large mediastinal cysts may present with stridor or dysphagia resulting from a mass effect on the trachea or esophagus.4
Occasionally, large cysts can be aspirated percutaneously for diagnostic or therapeutic indications.
Preferred Examination
Bronchogenic cysts are usually an incidental finding, and differentiating them from other pathologic conditions is important. On conventional radiographs, the appearances of mediastinal or lung masses are nonspecific and should be evaluated further using CT or MRI.5,6
Limitations of Techniques
Chest radiograph is usually adequate for detecting larger mediastinal or lung masses; however, it is limited in its ability to differentiate solid masses from fluid.
CT findings are characteristic when the lesion demonstrates water density. If the lesion demonstrates soft-tissue density, differentiating the cyst from lymph nodes or other solid lesions is difficult.
MRI findings are usually diagnostic for mediastinal cysts.
Intrapulmonary cysts are difficult to diagnose and must usually be aspirated to confirm the diagnosis.
Differential Diagnoses
Other Problems to Be Considered
Metastatic disease to the mediastinum
Reactive lymph node
Abscess
Pneumatocele
More on Bronchogenic Cyst |
 Overview: Bronchogenic Cyst |
| Imaging: Bronchogenic Cyst |
| Multimedia: Bronchogenic Cyst |
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References
Kumar AN. Perinatal management of common neonatal thoracic lesions. Indian J Pediatr. Sep 2008;75(9):931-7. [Medline].
Shah SK, Stayer SE, Hicks MJ, Brandt ML. Suprasternal bronchogenic cyst. J Pediatr Surg. Nov 2008;43(11):2115-7. [Medline].
Lima M, Gargano T, Ruggeri G, Manuele R, Gentili A, Pilu G, et al. [Clinical spectrum and management of congenital pulmonary cystic lesions]. Pediatr Med Chir. Mar-Apr 2008;30(2):79-88. [Medline].
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
