Bronchogenic cyst presenting as content of omphalocele - A case report

Subdiaphragmatic bronchogenic cysts: Case report and literature review

INTRODUCTION AND IMPORTANCE

Bronchogenic cysts are rare congenital malformations of the respiratory tract, arising from abnormal budding of the foregut during embryogenesis. Clinical manifestations vary by location and complications, ranging from asymptomatic to causing respiratory distress in newborns or recurrent respiratory issues in adults. Subdiaphragmatic bronchogenic cysts are extremely rare, with only a limited number of case reports published. They often present without symptoms or with nonspecific symptoms such as abdominal pain. Diagnosis typically relies on histopathologic analysis of excised biopsies performed during surgery. Due to their rarity and lack of distinctive clinical features, these cysts pose significant diagnostic challenges.

CASE PRESENTATION

A 36-year-old Iranian man, presented with a 5-month history of abdominal pain. Abdominal sonography revealed a cystic lesion posterior to the liver. An aspiration biopsy indicated an inflammatory process. An abdominal CT scan without contrast reported a right subdiaphragmatic cyst measuring 68 × 52 × 48 mm with a pressure effect on the liver. The diagnosis was uncertain. The cyst was surgically removed, and histopathologic studies confirmed it to be a bronchogenic cyst. The patient had an uneventful recovery with no recurrence after six months.

CLINICAL DISCUSSION

In addition to presenting our case report, we reviewed recent literature and added 24 new cases to the previously identified 100 cases of subdiaphragmatic bronchogenic cysts. Subdiaphragmatic bronchogenic cysts are rare lesions with no specific presentation, making diagnosis extremely challenging.

CONCLUSION

SBC is a benign lesion. Most patients are asymptomatic; however, due to the favorable prognosis following resection surgery, it remains the optimal management strategy.

Subdiaphragmatic bronchogenic cysts: Case series and literature review

Bronchogenic cysts are congenital malformations caused by aberrant foregut budding. They major occur in the thorax, with subdiaphragmatic cases being uncommon. Here, we present a series of 19 patients diagnosed with subdiaphragmatic bronchogenic cysts histopathologically at a single institution in China from 2012 to 2021. A literature review was also conducted by searching the PubMed database using keywords related to "bronchogenic cysts" and "subdiaphragmatic," yielding 107 cases. Taken together, the 126 cases had a median age of 41.0 years (interquartile range, 30.0-51.0 years) and 62 of them were male (49.2%). The cysts were most commonly detected in the left adrenal region (36.2%), followed by the pancreatic region (11.5%) and gastric cardia/lesser curvature of the stomach (9.2%). All patients except two underwent surgery for a definite diagnosis, symptom alleviation, and (or) malignancy prevention. Most patients recovered fast and were discharged from the hospital within 1 week after surgery, and the surgical complications were infrequent. The prognosis was generally favorable, as no recurrence was reported during the follow-up as long as 77 months.

Case Report: Prenatal and Postnatal Management for Fetal Bronchogenic Cysts During the COVID-19 Pandemic

Background: A fetal bronchogenic cyst (BC) is a rare congenital anomaly with an incidence of 0.147-0.238‰. The coronavirus disease 2019 (COVID-19) pandemic, as a particular situation, hindered pregnant women from receiving periodic prenatal checkups. Case Description: Until 34⁺⁶ weeks of gestation, a fetal case of the intrathoracic cyst was found by ultrasound examination. Further, MRI examination confirmed the diagnosis of the congenital mediastinal cystic lesion, probably a BC. Genetic testing was not conducted due to the COVID-19 pandemic. At 38⁺⁵ weeks of gestation with maternal COVID-19 testing negative, a live girl was delivered by cesarean section. Five months later, the child underwent bronchocystectomy, and the postoperative pathological lesions confirmed a (right upper mediastinum) BC. Conclusion: Herein, we reported the prenatal and postnatal management for a rare case of the congenital BC by multidisciplinary approaches during the COVID-19 pandemic. Fetal MRI and screening for fetal chromosomal abnormalities are especially recommended. This case contributes to the awareness that the COVID-19 pandemic interferes with regular follow-up schedules during pregnancy and may interfere with timely performed additional tests; which leads to more accurate genetic counseling. A combination of multidisciplinary approaches, including radiology, infection control, genetic counseling, obstetrics, and pediatric surgery, is pivotal for managing fetal BC during the COVID-19 pandemic.