Pediatric Bronchogenic Cyst Workup

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

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. However, contrast enhanced CT has largely replaced the esophagogram and can provide information about calcification.

  •   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 m Plain 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 ef 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: 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. [11, 12]

     

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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 bronchog 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.
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