Bronchogenic cyst removal via thoracoscopic surgery in the prone position: A case report and literature review

A Case of Intramural Esophageal Bronchogenic Cyst

A bronchogenic cyst is a congenital malformation with a rare esophageal origin. Occasionally, it is discovered incidentally, and excision is the only treatment. A 43-year-old patient was referred to our hospital for treatment of a cystic tumor in the left posterior mediastinum. We suspected the tumor was a bronchogenic cyst by imaging findings; therefore, we performed video-assisted thoracoscopic resection. The patient was discharged 9 days postoperatively. The tumor origin was found to be the esophageal wall. This report presents a rare case in which the esophageal wall was the origin of the bronchogenic cyst.

Cervical bronchogenic cyst in a toddler

Bronchogenic cyst is a congenital abnormality arising from the tracheobronchial system. Localisation of such cysts in the head and neck region is rare. We report a girl in her early childhood with a painless enlarging right lateral neck mass diagnosed with a branchial cleft cyst based on clinical and radiological MRI findings. An incidental finding of a cervical bronchogenic cyst was made on the final histopathological specimen. Although rare, bronchogenic cysts should be considered as differential diagnoses for paediatric patients' lateral and midline cervical masses.

[Diagnosis and treatment of pediatric cervical bronchogenic cyst]

Objective:To investigate the clinical characteristics and surgical treatment outcomes of children with cervical bronchogenic cysts. Methods:A retrospective study of 6 pediatric patients with bronchogenic cysts in the neck region treated in our hospital during 2014 to 2020 was performed. All children underwent complete resection of cervical mass under general anesthesia. Results:There were 6 children, aged from 1 to 5 years, with a median of 2.25 years. There were 3 males and 3 females. The lesions were located on the left neck in 3 cases, the midline neck in 2 cases and the right neck in 1 case. The clinical manifestations were painless mass in 5 cases and recurrent neck infection in 1 case. The size of the mass ranged from 2.1 to 7.5 cm. There was no characteristic clinical or imaging features of bronchogenic cysts. Misdiagnosed as lymphangioma in 3 cases, thyroglossal cyst in 2 cases and piriform fistula in 1 case. The follow-up ranged from 1.50 to 7.75 years, with a median of 4.13 years. All 6 children had no recurrence or complications. Conclusion:Although rare, bronchogenic cysts should be considered in the differential diagnosis of cervical cystic masses in children. Surgery is the most effective way to treat cervical bronchogenic cyst, and histopathological examination is the gold standard for diagnosis.

Surgical approaches to mediastinal cysts: clinical practice review

The traditional approach to mediastinal cyst and mass resection has been open via median sternotomy or thoracotomy. With the advent of minimally invasive techniques, there have been successful cases completed via video-assisted thoracoscopic (VATS) and robot-assisted thoracoscopic surgery (RATS). Although mediastinal cysts are uncommon, they are a significant and relevant topic in the practice of thoracic surgery. Thus, this clinical practice review aims to summarize and highlight some of the key case series and retrospective studies in order to provide insight on each of the approaches. In addition, there is a brief review of other approaches, such as subxiphoid, and the utility of endobronchial ultrasound in the management of mediastinal cysts. In this review, the identified benefits of VATS and RATS lie largely in quality improvement of the patient experience-decreased length of stay (LOS) and pain-without compromising patient outcomes. However, the open approach remains a viable option, particularly for the management of large cysts or as a bail-out option. When surgeons approach with VATS or RATS and encounter bleeding or difficult dissection planes, it is consistent in the literature that conversion to thoracotomy is the safe next step. Our clinical practice is to attempt VATS or RATS approach for mediastinal cysts when possible. The data used for this review relies heavily on case reports and case series, and thus is the main limitation of this clinical practice review.

Bronchogenic cyst with atypical imaging findings and repeated ruptures in a short period of time: A case report

Bronchogenic cysts are the most common primary cysts of the mediastinum. Although most are asymptomatic, some bronchogenic cysts cause symptoms such as chest pain and dyspnea. Here, we report a case of bronchogenic cyst that ruptured twice in a short period of time in a patient who presented with sudden back pain. The lesion was apparent on computed tomography (CT) as a mass lesion with heterogeneous and high attenuation in the posterior mediastinal region. CT-guided puncture performed for diagnostic purposes revealed the contents as bloody fluid. The patient suffered chest pain approximately 3 months after the first presentation, and re-growth and re-rupture of the mass was suspected. The lesion was surgically resected and pathologically diagnosed as a bronchogenic cyst. Spontaneous rupture is a very rare complication of bronchogenic cyst, usually into the trachea, pleural cavity, or pericardial cavity. However, there are no reports of multiple ruptures. This case highlights the importance of recognizing the atypical imaging findings of bronchogenic cyst and the rare complication of rupture.

Videothoracoscopic excision of a diaphragmatic bronchogenic cyst appearing as a pulmonary lesion

Diaphragmatic bronchogenic cysts are rare, and very few cases have been reported in the literature to date. Herein, we present a 42-year-old male patient who had a diaphragmatic bronchogenic cyst with the radiologic appearance of an intrapulmonary lesion as the 32nd case in the English literature. We performed a videothoracoscopic excision of the cyst, which was later found to be originated from the diaphragm. Pathologic examination confirmed the diagnosis of the bronchogenic cyst. Diaphragmatic bronchogenic cysts may present as intrapulmonary lesions radiologically. Videothoracoscopic excision is a feasible treatment method for these lesions.

Pediatric bronchogenic cysts in the head and neck region: A study of 10 surgical cases and a review of the literature

OBJECTIVE

To explore the clinical characteristics and surgical treatment of children with bronchogenic cysts (BCs) in the head and neck region.

METHODS

A retrospective study of 10 pediatric patients with BCs in the head and neck region treated in Shanghai Children's Hospital during 2011 to 2022 was performed.

RESULTS

Based on their pathological diagnosis, 10 patients with BCs in the head and neck were identified. The most common location was the neck (8 patients, 80%; 2 midline neck, 6 lateral neck), followed by the ventral tip of tongue (1 patient), and the posterior pharyngeal wall (1 patient). Misdiagnosed as lymphangioma in 5 cases, cyst in 3 cases, thyroglossal duct cyst (TGDC) in 2 cases and congenital pyriform sinus fistula (CPSF) in 1 case preoperative. The median follow-up period after surgery was 4.68 (range, 0.67-9.25) years. All 10 patients underwent complete resection without recurrence or other complications.

CONCLUSIONS

Although extremely rare, BCs should be considered in the differential diagnosis of midline and lateral neck masses or intraoral cysts in children. Surgical excision is recommended in BCs, and the diagnosis is definitively confirmed by histopathology.

Paratracheal air cyst and bronchogenic cyst in patients with esophageal cancer who received thoracoscopic esophagectomy: A case series of three patients

INTRODUCTION AND IMPORTANCE

Mediastinal cystic lesions, such as paratracheal air cyst (PTAC) and bronchogenic cyst (BC), are rare anomaly usually found incidentally in thoracic imaging. Special attention is needed in the case of thoracic surgery.

CASE PRESENTATION

All three patients were male, 71, 73, and 76 years old. Preoperative CT showed each had a lobular cystic lesion at the right posterolateral side of trachea in the thoracic outlet 11, 14, and 19 mm in size, respectively, with air density and tracheal communication, leading to a diagnosis of PTACs. An oval cystic lesion, 7 mm in size, was found in one patient at the right lateral side of the upper esophagus with low density and without tracheal communication, leading to a diagnosis of paraesophageal BC. Intraoperative findings of the three PTACs demonstrated a soft bulge from the membranous portion of trachea that was left intact. The BC had an oval elastic structure, mimicking a metastatic lymph node, and was removed with the mediastinal lymph nodes. Histological examination showed ciliated columnar epithelium, confirming a diagnosis of BC.

CLINICAL DISCUSSION

PTACs are associated with increased intraluminal pressure due to chronic lung disease. BCs are congenital anomalies that originate from abnormal budding of the embryonic foregut.

CONCLUSION

PTACs and BCs need to be considered in preoperative image diagnosis in patients with esophageal cancer. PTACs should be left intact to avoid tracheal injury, while removal of isolated BCs is recommended as a diagnostic and therapeutic measure.

Giant Intrapericardial bronchogenic cyst associated with congestive heart failure and atrial fibrillation: a case report

Background

Large intracardiac bronchogenic cysts are rare mediastinal masses. However, they must always be considered in the differential diagnosis of heart failure with abnormal chest X-ray.

Case presentation

We present a 60-year-old female patient with de novo atrial fibrillation, heart failure and a very large intrapericardial mass. The patient underwent successful surgical resection, with pathological findings confirming a bronchogenic cyst.

Conclusions

Large bronchogenic cysts located intrapericardially are very rare. However, they should be included in the differential diagnosis of patients presenting with atrial fibrillation and heart failure with abnormal radiologic studies.

A Clinical Analysis of Pharyngeal Bronchogenic Cysts in the Pharynx of Children

Objective: This study was designed to summarize the clinical characteristics, diagnosis and treatment of pharyngeal bronchogenic cysts in children to help in making the correct diagnosis and developing an appropriate treatment plan. Methods: The clinical data of 13 children with bronchogenic cysts in the pharynx, who were treated in otolaryngology head and neck surgery department between September 2013 and July 2019, were analyzed retrospectively. The clinical characteristics were evaluated, and the related factors for diagnosis and treatment were analyzed. Clinical characteristics and imaging features of three cases whose lesions located in the nasopharyngeal, oropharynx, and laryngopharyngeal were demonstrated. Results: All 13 children were male, the youngest being 4 days old, the oldest 6 years and 6 months, and the median age being 1 year and 4 months. Eight patients were diagnosed during a physical examination, and five patients visited the doctor with different degrees of upper airway obstruction. The mass was located in the nasopharynx in one patient, in the oropharynx in eight patients, and in the laryngopharynx in the other four patients. Computed tomography (CT) scanning, which is helpful for a topical diagnosis, showed a dense homogeneous mass. Electronic nasopharyngoscopy showed cystic masses of different sizes in the pharynx. All the children underwent cyst resection under general anesthesia, and the postoperative pathology result was a bronchogenic cyst. One child was lost to follow-up, but the remaining 12 children were followed up for between 6 months and 6 years, during which no recurrence of a cyst was found. Conclusion: Bronchogenic cysts are a rare cyst of the head and neck, and the most common site of the cyst is the oropharynx. The impact on airway obstruction depends on the location and size of the cyst. CT scanning is of great significance for diagnosis. Surgical treatment should be carried out as soon as possible after diagnosis, as surgery is the most effective way to treat bronchogenic cysts. Follow-ups should be carried out regularly to prevent cyst recurrence.