Asymptomatic bronchogenic cyst of the mediastinum

Total occlusion of the superior vena cava due to bronchogenic cyst

Bronchogenic cysts are the most common form of congenital cystic lesions in the mediastinum. Of all cases with bronchogenic cysts, 1/3 are symptomatic. The symptoms vary depending on the location and compression of the adjacent structures of the cyst. Some mediastinal bronchogenic cysts can cause severe respiratory distress due to airway and vascular compression. We herein present a case with a bronchogenic cyst that required venoplasty to the superior vena cava (SVC) due to total occlusion of the SVC.

Bronchogenic cysts

Between 1967 and 1987, 26 patients with bronchogenic cysts were treated in our institution: 15 females and 11 males, ranging in age from 2 months to 14 years (average 6 years, 4 months). Only four patients (15%) were 1 year old or less. Seven patients presented with asymptomatic lesions discovered on chest film. Nineteen patients presented with respiratory symptoms. Of note are the four patients aged 1 year or less, who presented with dyspnea and cyanotic spells. Only one of them presented with dysphagia. All patients underwent routine chest films and tomography and, later, computed tomography (CT) scan of the thorax once the study became available. Barium esophagogram and bronchoscopy were performed as required. Contrary to what has been published concerning the intraparenchymal location of bronchogenic cysts, the majority of the cysts (65%) were located in the mediastinum, usually in close proximity to the carina, mainstem bronchi, trachea, esophagus, or pericardium. Only 27% (7 of 26) were intraparenchymal, and 8% (2 of 26) were situated in the inferior pulmonary ligament. A correct preoperative diagnosis was made in 19 patients (73%). Intrapulmonary lesions were removed by segmentectomy or lobectomy. Cysts located elsewhere were simply excised. Among the cysts adhering to the trachea, 50% (two of four) required suture of the membranous trachea after excision. Postoperative complications included one pneumonia, which responded to antibiotics, and one transient paresis of the right phrenic nerve. Follow-up averaged 17 months (range, 0 to 17 years). No sequelae were noted and all patients were cured.

A case of bronchogenic cyst with high production of antigen CA 19-9

A 35-year-old man was hospitalized with complaints of retrosternal pain and high fever. A chest radiograph showed a large round mass in the mediastinum. Of the several tumor markers in the serum tested, only CA 19-9 was elevated. Thoracotomy revealed a cystic mass with purulent hemorrhagic materials. Histologically the cyst was lined by bronchial epithelium with no evidence of malignancy. The high level of CA 19-9 in the cystic fluid, and positive immunohistochemical staining of the bronchial glands in the cyst wall for CA 19-9 indicated that the elevated serum level of CA 19-9 originated from the bronchogenic cyst after its infection.