Pediatric Bronchogenic Cyst Clinical Presentation

Updated: Jan 18, 2017
  • Author: Mary E Cataletto, MD; Chief Editor: Girish D Sharma, MD, FCCP, FAAP  more...
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Presentation

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. [9]

  • 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]

  • Jiang et al (2015) reported on 16 pediatric cases of bronchogenic cyst. Of those with palpable lesions in the neck or on the skin, only one was symptomatic (mild stridor). In the remaining eight cases, seven were located in the mediastinum and one was pulmonary; 75% of these children were symptomatic. These findings were in contrast to the 23 adults studied where 56% of the overall adult group were asymptomatic. [10]

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Physical

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  • 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

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  • Cysts are believed to result from abnormal development of the ventral foregut and lung budding during the first 4-6 weeks of gestation.

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Complications

Airway compromise

Infection

 

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