Bronchogenic Cysts of the Lung: Report of 29 Cases

doi:10.1016/j.hlc.2008.10.011

Heart, Lung and Circulation

Volume 18, Issue 3, June 2009, Pages 214-218

https://doi.org/10.1016/j.hlc.2008.10.011 Get rights and content

Background

Intrapulmonary bronchogenic cysts are congenital anomalies of the tracheobronchial tree and foregut. The aim of this retrospective study was to review the diagnosis, clinical and histological features, operative techniques, outcomes and follow-up of intrapulmonary bronchogenic cysts treated in a single institute.

Methods

Twenty-nine patients with intrapulmonary bronchogenic cysts were treated surgically between 1990 and 2005. There were 17 female and 12 male patients and their ages ranged from 7 to 68 years. Patients were divided into two groups according to surgical procedure. Resection (lobectomy or wedge resection) was performed on Group I (n = 18), and partial excision with de-epithelisation was performed on Group II (n = 11).

Results

Twenty-five patients (86.2%) were symptomatic. Cough and sputum were the most common symptoms. Twenty-four of the 29 BCs were simple cysts (82.7%) whereas 5 (17.3%) were complicated cysts. Postoperative hospital stay was 4.55 ± 0.86 days in group I and 6.54 ± 3.34 days in group II (P = 0.172). Complications in Group I were pneumonia in one case and wound infection in two cases; prolonged air leakage were observed in two cases of Group II. No statistical difference was determined between the complication rates of the two groups (P = 0.91). However a significant difference was determined between the complication rates of simple and complicated cysts (P = 0.026). Two cases in Group II showed recurrence, whereas no recurrence occurred in Group I. (P = 0.065) No postoperative mortality was observed in any of the groups.

Conclusions

All bronchogenic cysts should be treated surgically. We believe that partial excision with de-epithelisation may be an alternative to resection in symptomatic patients with limited respiratory capacity.

Introduction

Congenital foregut cysts are classified as bronchogenic cysts (BCs), which can be mediastinal or intrapulmonary [1], [2], [3]. BCs that arise in later gestation are located within the lung parenchyma, where they often have a patent communication with the tracheobronchial tree and cause symptoms of recurrent and chronic pulmonary infection. BCs are more commonly located in the mediastinum, intrapulmonary cysts represent about 15–20% of all the BCs and usually occur in the lower lobes. They are observed not only in infants and children, but also late in adults [4], [5]. BCs may lead to compression, haemorrhage, and infection and thus be life-threatening [1]. The aim of this retrospective study was to investigate the diagnosis, clinical and histological features, determine the optimal surgical treatment, outcomes and, follow-up of intrapulmonary BCs, in a series consisting of 29 patients at a single hospital.

Section snippets

Patients and Methods

Thirty-seven bronchogenic cyst patients, histopathologically diagnosed by the inner surface covered with ciliated respiratory epithelium containing cartilage, smooth-muscle elements, and bronchial gland tissue were operated on between the years 1990 and 2005 in our Center. Twenty-nine (78.4%) intrapulmonary located BCs were included in our study (8 BCs with mediastinal localisation were excluded). Seventeen patients were female (58.6%) and 12 were male (41.4%). The mean age was 21.6 years

Results

Twenty-five (86.2%) of the patients were symptomatic, 4 (13.8%) were asymptomatic. The most common symptoms were cough and sputum. Other symptoms included chest pain, breathlessness, haemoptysis, and fever (Table 1). The majority of bronchogenic cysts were located in the lower lobes (65.6%). Localisations of the bronchogenic cysts are summarised in Table 2. There was only one cyst in all patients. Among these 29 bronchogenic cysts, 24 (82.7%) were simple. There were 5 (17.3%) complicated cysts.

Discussion

Bronchogenic cysts are congenital lesions arising from the abnormal budding of the ventral foregut that occurs between the 26th and 40th days of gestation. Depending on time of separation from the primary airways, BCs may present as mediastinal cysts close to the tracheobronchial tree or as pulmonary cysts within the lung parenchyma [1], [2], [6]. The majority of BCs are located mediastinally. However, controversial to the literature, our series included a majority of intrapulmonary

Acknowledgment

The authors would like to thank Sedat Ziyade M.D. (Vakif Gureba Teaching and Research Hospital) for his valuable efforts to gather the statistical data in our manuscript.

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2023, Journal of Pediatric Surgery
Bronchogenic cysts are benign congenital malformations of the primitive ventral foregut. The aim of this study is to analyze and report 20 years of experience in the diagnosis and treatment of bronchogenic cysts at a tertiary pediatric center.
A retrospective review was conducted of all patients diagnosed with a bronchogenic cyst between 2000–2020. Presence of symptoms, cyst location, surgical technique, postoperative complications, need for pleural drainage, and recurrence were reviewed.
Forty-five children were included in the study. In 37 patients a partial resection of the cyst was done, followed by cauterization or chemical obliterateration with iodopovidone of the mucosa of the remaining cyst wall that was adherent to the airway. A lobectomy was done in patients who had intrapulmonary cysts (n = 8). Cyst location was subcarinal in 23 (51.1%), paratracheal in 14 (31.1%), and intrapulmonary in eight patients (17.8%). The majority of subcarinal and paratracheal cysts (90%) were approached by thoracoscopy. Complications occurred in seven patients (15%): subcutaneous emphysema after pleural drain removal in one, extubation failure in two, reoperation due to bleeding in one, surgical site infection in one, bronchopleural fistula in one, and pneumothorax in one. Reoperation due to cyst recurrence was necessary in two patients (4.4%). Mean follow-up was 56 months (range, 0–115).
A minimally invasive approach is a safe option for the management of paratracheal and subcarinal bronchogenic cysts with no history of infection in specialized pediatric surgery center. Thoracoscopic partial resection is a feasible option in most patients with subcarinal and paratracheal bronchogenic cysts with a low complication and reoperation rate.
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Subcutaneous bronchogenic cyst of the chest wall: A case report with brief literature review
2022, International Journal of Surgery Case Reports
Bronchogenic cysts are congenital lesions found in the mediastinum, particularly the posterior-superior area. The current study aims to report a rare case of a subcutaneous bronchogenic cyst in the chest wall.
A 41-year-old patient presented with a swelling of the chest wall. The mass had been present since birth. On examination, there was a large soft, round mass over the sternum subcutaneously. It was a fixed, non-flatulence, non-pulsatile, and non-tender mass.
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No recurrence has been observed (Figs. 1–3). Bronchogenic cysts manifest as solitary or multiple lesions, majority of which are located in the mediastinum while sometimes can occur in the lung parenchyma [4]. Macroscopically, they may appear uni or multilocular and contain clear fluid, hemorrhagic secretions or air.
The mediastinal bronchogenic cysts represents 50%–60% of mediastinal cysts and rarely occurs in the posterior mediastinum. The final surgical resection is indicated for symptomatic patients and is recommended for some asymptomatic patients in order to establish the diagnosis and to avoid any subsequent complications.
We report a case of 17 years-old male suffering from bronchogenic cysts of the mediastinum. The patient was admitted to our hospital complaining with dry chough and dyspnea; CT scan showed a cystic mass in posterior mediastinum. To achieve a correct diagnosis and to prevent the risk of complications, a complete surgical resection was performed by using bilateral simultaneous VATS.
Bronchogenic cysts manifest as solitary or multiple lesions, majority of which are located in the mediastinum while sometimes can occur in the lung parenchyma. They are usually asymptomatic and casually discovered at chest X-ray or CT scan. The most common complications are infections, pneumothorax and hemoptysis. The complete surgical resection is the only radical and definitive treatment of the bronchogenic mediastinal cysts. VATS permits good exposure of the thoracic cavity including the mediastinum and better evaluation of the anatomic relationship. The absence of intra and postoperative complications, the reduction of pain in the early postoperative period demonstrate the security of this approach.
Bilateral simultaneous VATS for resection of bilateral posterior mediastinal bronchogenic cyst may be a useful approach. In our case no intra and post-operative complications occurred and patient discharged home on 4 rd day.
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For extrapulmonary BCs resection depends on the degrees of adhesion; total resection is very important. If there are severe adhesions to vital structures, subtotal resection with de-epithelisation may be a good alternative; the residual epithelial layer should be destroyed by toxic agents (such an ethanol, silver nitrate) or electro-cauterization [39]. VATS is safe and feasible, and can be considered the primary therapeutic option in the management of mediastinal bronchogenic cyst with encouraging results [34–36], Jung HS and al [34].
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Bronchogenic cysts are rare congenital malformations of the tracheobronchial tree and are mostly found in an intrathoracic location. We report a very rare case of a double location – cervical and mediastinal – in a young female patient.

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Copyright © 2008 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier Ltd. on behalf of The Australasian Society of Cardiac and Thoracic Surgeons and The Cardiac Society of Australia and New Zealand All rights reserved.

Original ArticleBronchogenic Cysts of the Lung: Report of 29 Cases

Background

Methods

Results

Conclusions

Introduction

Section snippets

Patients and Methods

Results

Discussion

Acknowledgment

Ann Thorac Surg

Chest

J Thorac Cardiovasc Surg

Chest

Chest

Ann Thorac Surg

J Thorac Cardiovasc Surg

Ann Thorac Surg

Ann Thorac Surg

Original Article
Bronchogenic Cysts of the Lung: Report of 29 Cases