Cervical bronchogenic cyst that presented as a thyroid cyst

Thyroid "claw sign" a useful diagnostic marker in the outsized lesions of isthmus: A large colloid cyst

Thyroid isthmus lesions are generally small sized and can be solid or cystic. Discerning isthmic origin of a large nodule, especially if purely cystic, can become a diagnostic challenge because of thin thyroid tissue in it. We report a case of a 68-year-old male patient who had 6 weeks history of non- inflammatory central neck swelling associated with recent dysphagia, for which he underwent ultrasound and computed tomography (CT) scan examinations. Colloid nodules usually do not require further attention. Despite being commonest and benign thyroid nodules, they may require treatment if causing pressure symptoms. Its imaging characteristics can be variable, but they usually exhibit comet tail artifacts on ultrasound. In equivocal cases, claw sign on CT scan is diagnostic to confirm the site. Radiologists have a principle role to rule out other differentials of cystic neck lesions by careful examination of imaging features. In our case, CT scan allowed to rule out primary differential of thyroglossal cyst and guided clinicians for specific management plan.

Bronchogenic cyst of the neck in an elder patient: A case report

INTRODUCTION

Bronchogenic cysts are rare malformations, mostly diagnosed in children. We report the rare case of a neck bronchogenic cyst diagnosed in an elderly patient.

PRESENTATION OF CASE

The patient complained of a long-standing submental mass. The diagnostic work-up resulted in a thyroglossal duct cyst diagnosis for which the patient underwent a Sistrunk procedure. However, the histological analysis of the lesion ultimately revealed a bronchogenic cyst.

DISCUSSION

Neck bronchogenic cysts are rare and, in adults, normally asymptomatic. Imaging exams can suggest the diagnosis but they are most important for surgical planning. Surgery is the elected treatment for bronchogenic cysts and the histopathologic exam of the specimen provides definitive diagnosis.

CONCLUSION

This case demonstrates than even though they are a rare diagnosis, bronchogenic cysts should be considered in the diagnostic work-up of neck cysts, even in elderly patients.

Cervical bronchogenic cysts mimic metastatic lymph nodes during thyroid cancer surgery

Purpose

Although congenital bronchogenic cysts in the cervical region, especially in the thyroid or perithyroidal area, are rare, distinguishing them from other cervical cystic lesions (e.g., thyroglossal duct and branchial cleft cysts) and metastatic cervical lymph nodes is difficult preoperatively. Additionally, cystic degeneration of metastatic lymph nodes is common in patients with thyroid cancer. We investigated the clinical characteristics and proper treatment for individuals with cervical bronchogenic cysts.

Methods

Of the 18,900 patients treated for thyroid cancer, 18 patients with pathologically confirmed bronchogenic cysts were retrospectively reviewed. Bilateral total thyroidectomy or less than total thyroidectomy with central compartment node dissection, including cystic mass excision was done and cystic mass was confirmed by postoperative pathologic examination.

Results

All cervical bronchogenic cysts were asymptomatic. Their mean size was 1.2 cm (range, 0.3 to 3 cm). Of these 18 patients, 15 did not have any abnormal radiological findings, except for lymphadenopathy during preoperative evaluations. Most bronchogenic cysts were detected around the thyroid and paratracheal areas. On preoperative imaging and intraoperatively, most were indistinguishable from metastatic cervical lymph nodes or other cystic lesions.

Conclusion

Although cervical bronchogenic cysts are rare and benign, they should be distinguished from other cystic cervical masses, especially metastatic cervical lymph nodes associated with thyroid cancer. Possible cervical bronchogenic cysts found during thyroid cancer evaluation or surgery should be surgically excised.

Inner cyst approach, remove bronchial cervical cyst

Although most cystic lesions in young adults represent a branchial cleft cyst, the bronchial cervical cyst is not rare (Acta Oto-Laryngologica 2010;130:300). Surgical excision is both diagnostic and curative and also eliminates the risk of infection or recurrence. As we have all known, it is hard to protect some important structures in an inflamed tissue, especially in infants. However, a correct approach can avoid this kind of iatrogenic injury. An accurate diagnosis is always by pathologic examination. The diagnosis can be made before operation when finding cartilage in the nodule. We present the preoperative diagnosis by finding gas in the nodule and removed it by inner cyst approach without surrounding tissue injury.

An unexpected finding of a bronchogenic cyst presenting as a thyroid mass

Herein we present a case of a bronchogenic cyst masquerading as a thyroid mass. Bronchogenic cysts are rare congenital malformations that result from an abnormal development of the ventral foregut during organogenesis. They are commonly asymptomatic lesions rarely found in the neck. In our case, a young male presented with complaints of neck discomfort over a long period presumed to be secondary to a thyroid mass based on imaging studies. Fine needle aspiration was inconclusive. Post-operative pathological sectioning revealed evidence of a bronchogenic cyst. These lesions have a low incidence of malignancy, and complete surgical excision has been recommended.

Cervical bronchogenic cyst: asymptomatic neck mass in an adult male

Bronchogenic cysts are rare congenital malformations of ventral foregut development. They are usually located in the mediastinum and intrapulmonary regions. Localization in the cervical area is unusual and the majority of cases reported have been found in the pediatric population: the literature reports few cases in adults. We describe a 57-year-old male who presented an asymptomatic right lateral neck mass. Diagnostic studies included chest X-ray, pharyngo-esophagus double-contrast X-ray, computed tomography (CT), and bronchoscopy. The mass was excised through a transverse right cervical skin incision. The right lateral neck mass of the patient was identified as a bronchogenic cyst. The embryology, the presentation, the pathological and radiological evaluation, treatment of the cyst and a review of the English literature are reported in this paper. Cervical bronchogenic cysts are usually diagnosed in the pediatric population; these lesions are rare in adults. We suggest that the clinical observation of an asymptomatic lateral neck mass in an adult should include the possibility of a bronchogenic cyst in the differential diagnosis. Surgical excision is the elective treatment for this tumor, in order to prevent complications including infection, compression symptoms, malignant transformation, and the rare but fatal air embolism.

Bronchogenic cysts of the neck in adults

Bronchogenic cysts are congenital sacs that result from maldevelopment of the primitive foregut. Although they occur predominantly in the chest, there are reports of lesions in extrathoracic locations. The majority of reported bronchogenic cysts located in the neck are found in the pediatric population; a review of the literature reveals few reports of bronchogenic cysts of the neck among adults. The diagnosis of a bronchogenic cyst relies on the histology and location of the lesion. Here, we review our experience in the diagnosis and management of 2 adult patients with pathologically proven bronchogenic cysts. Both patients presented with solitary neck masses that proved to be bronchogenic cysts on histologic examination. Our purpose is to define the histopathologic and clinical characteristics of bronchogenic cysts and discuss the features that distinguish them from other cervical cysts. In conclusion, congenital bronchogenic cysts can occur in the neck of adults and should be considered in the differential diagnosis of cystic cervical masses in adults, as well as children.