Unknown: a congenital nodule on the scapula

We present a new case of a cutaneous bronchogenic cyst on the scapular area in a 2-year-old boy. The asymptomatic nodule over his right scapula had been detected at birth and had been gradually growing. Cutaneous bronchogenic cysts located near the scapula are extremely rare. The proposed mechanism is that the accessory buds from the tracheobronchial tree/primitive foregut migrated from the thorax in an aberrant manner to lie in a periscapular position. Cutaneous bronchogenic cysts are poorly recognized by clinicians because they lack pathognomonic clinical symptoms. The diagnosis is based on the histopathological findings in the majority of cases. Complete excision and histological examination are indicated to confirm the diagnosis, to relieve symptoms, and to prevent complications, such as infection or malignancy.

Gastric duplication cysts as a rare cause of haematemesis: diagnostic challenges in two children

Gastric duplication cysts are rare congenital alimentary tract anomalies. We describe the importance of imaging in two children with haematemesis due to gastric duplication cysts. We emphasize the necessity for a high clinical index of suspicion for early diagnosis.

Congenital cystic lesions of the head and neck

This article presents clinical characteristics and radiologic features of congenital cervical cystic masses, among them thyroglossal duct cysts, cystic hygromas, branchial cleft cysts, and the some of the rare congenital cysts, such as thymic and cervical bronchogenic cysts. The imaging options and the value of each for particular masses, as well as present clinical and radiologic images for each, are discussed.

[Cystic pulmonary malformations: clinical and radiological polymorphism. A report on 30 cases]

OBJECTIVES

This report describes different clinical pictures of cystic pulmonary malformation (CPM) and problems in diagnosis.

PATIENTS AND METHODS

Cases of CPM between 01 January 1994 and 31 December 2004 diagnosed in our institution were reviewed.

RESULTS

Thirty-three cases of CPM were diagnosed in 30 children. They consisted of 17 boys and 13 girls ranging from 20 days to 16 years of age at the time of the diagnosis. The CPM included: 17 cases of congenital lobar emphysema (CLE), seven bronchogenic cysts (BC), five cystic adenomatoid malformations (CAM) and four pulmonary sequestrations (PS). Three patients presented two associated lung malformations. The mean ages at the time of diagnosis varied from 2 to 88 months. The symptoms consisted of respiratory distress (n=14, 46.6%); recurrent attacks of respiratory embarrassment (n=6, 20%); pulmonary infection (n=8, 26.6%) associated with haemoptysis in two cases; haemothorax (n=1) and a chance discovery (n=1). Radiological investigations led to the diagnosis in all cases of CLE and CAM although it contributed less to the diagnosis of BC and PS. Twenty-nine patients required chirurgical treatment involving lobectomy (n=22), pneumonectomy (n=2) and cystectomy (n=8). The histopathological examinations confirmed the diagnosis in all cases and rectified the preoperative diagnosis in four cases. Except for one patient with CLE, who died a few days after a lobectomy due to acute nosocomial pneumonia, the postoperative period was uneventful in 26 children with a mean of follow-up of 24 months (4 months to 7 years). Three patients developed transient and episodic attacks of dyspnoea.

CONCLUSION

CPM may be responsible for many clinical and radiological pictures that present difficulties in their diagnosis. Polymorphism is related to the type of malformation, its topography and the evolutive complications.

Congenital cystic adenomatoid malformation and bronchogenic cyst in a 4-month-old infant

Congenital cystic disease of the lung and mediastinum encompasses a continuum of entities, and a histological overlap of many of these anomalies is acknowledged. Moreover, it is possible for different lesions to coexist in the same patient. Careful evaluation prior to surgical resection will alert the surgeon to the possible presence of multiple lesions in one patient.

[A case of bronchogenic cyst coexisted with intrapulmonary and pleural cysts]

A 39-year old woman presented with cough. Computed tomography showed a mass in the lower lobe of the right lung. Although bronchofiberscope was performed, accurate diagnosis of the tumor was not obtained. Based on the characteristics of the tumor from the results of chest MRI and PET-CT, a diagnosis of bronchogenic cyst with infection was suspected. Therefore, surgical resection was performed, revealing an intrapulmonary bronchogenic cyst and another tumor of the pleura on the vertebral body. Pathological findings demonstrated that the wall of the intrapulmonary tumor was covered with many ciliated epithelia and bronchial cartilages, suggesting a diagnosis of bronchogenic cyst. The tumor on the pleura was also diagnosed to be bronchogenic cyst based on pathological findings. Therefore, we diagnosed both intrapulmonary and pleural cysts.

Clinical spectrum and management of congenital pulmonary cystic lesions

INTRODUCTION

Congenital cystic lesions of the lung in children are uncommon but potentially life-threatening and warrant an urgent diagnostic work-up. Pulmonary sequestration (PS), congenital cystic adenomatoid malformation (CCAM), congenital lobar emphysema (CLE), and bronchogenic cyst (BC) are the four major congenital cystic lesions, but they share similar embryologic and clinical characteristics. The purpose of this study is to review our institutional experience with congenital cystic lung disease emphasizing on diagnosis and management.

PATIENTS AND METHODS

Between January 1975 and October 2007, 109 patients have been treated, of which 57 males and 52 females, the age ranged from the birth to 13 years. 104 patients presented solitary lesions: CCAM (47), CLE (16), PS (22), BC (19). The remainders 5 patients presented two simultaneous lesions: intralobar PS and CCAM (2), CLE and CCAM (3).

RESULTS

All the lesions have been treated surgically: in the first cases, only symptomatic patients underwent surgery, while in the last years, patients have systematically been submitted operated.

CONCLUSIONS

A meaningful percentage of CCAM joins to PS and CLE; instead the BC are generally isolated, probably deriving by a more precocious embryogenetic defect. The treatment of these lesions is surgical: CCAM (type I-II) and CLE should be treated promptly in newborns for respiratory distress and pneumothorax; CCAM (type II) and BC generally become symptomatic gradually and expose to degenerative risk; intralobar PS generally becomes symptomatic and surgery prevents the risk of infections. Extralobar PS and the asymptomatic BC are not exempted by surgical approach whenever accidentally described as masses of uncertain nature. Asymptomatic cysts in children should be resected, to avoid later complications of the cysts, which could make operation more difficult. Conservative anatomic resections should be attempted to preserve functional lung tissue. Careful histologic examination of the resection specimen is mandatory to identify occult malignancy. In conclusion a correct embryogenetic organization and a clinical evaluation of the congenital cystic lung diseases allow a precocious and effective surgical timing.

Progressive intraparenchymal bronchogenic cyst in a neonate

Neonatal parenchymal bronchogenic cysts (BC) are a very rare congenital anomaly. Usually patients with BC are born with severe respiratory distress or cardiovascular insufficiency are asymptomatic till they grow up to older children and adults. We report a case of neonatal BC with a prenatal diagnosis of congenital tracheobronchial cystic anomalies of the right lung. The cyst was 36 mm in diameter at 17 week gestational period but diminished in size to 21 mm at 35 weeks. After birth, chest X-ray demonstrated a growing cyst 50 mm in diameter and gradual displacement of the heart and mediastinum from the right to the left day by day. Right S3 segmentectomy was performed on the 5th day.

Infected intraparenchymal bronchogenic cyst mimicking recurrent lung abscess in a young adult

A 23 year old female with a past history of a lung abscess diagnosed at the age of 13 years presented with recurrent episodes of productive cough. Chest radiograph and a high resolution CT scan of the thorax led to the diagnosis of a left lower lobe lung abscess. She underwent a successful thoracotomy and a left lower lobe lobectomy. Histopathological examination revealed the diagnosis of an infected congenital bronchogenic cyst. The recent literature on this is reviewed.

Congenital malformations of the lung

Congenital malformations of the lung are rare and vary widely in their presentation and severity. The most common manifestation of the congenital cystic disease of the lung at newborn and early infancy is respiratory distress. Later on in life, cysts usually lose this compressive character and may remain asymptomatic until infection occurs, while producing cough, dyspnea and thoracic pain. The purpose of this study is to review authors institutional experience of congenital cystic lung disease, with specific reference to diagnosis, treatment, as well as outcome, furthermore, to present some cases with unusual clinical manifestations.

A case of an upper cervical bronchogenic cyst in an adult

We herein report a case of a rare cervical cystic lesion, namely a congenital bronchogenic cyst, which presented as an asymptomatic upper cervical mass in a 22-year-old female. Although cervical bronchogenic cysts are rare lesions in adults which are very difficult to accurately diagnose preoperatively, they deserve inclusion in the differential diagnosis of cervical cystic lesions.

Gastric mucosa in a bronchogenic cutaneous cyst in a child: case report and review of literature

We report a case of cutaneous bronchogenic cyst, partially lined by gastric mucosa of antral type in a 9-year-old boy. This is, to the best of our knowledge, the first report of gastric mucosa in bronchogenic cutaneous cyst in the literature.

Intralobular bronchopulmonary sequestrations associated with bronchogenic cysts

We present three cases of intralobar bronchopulmonary sequestrations with associated congenital bronchogenic cysts. As congenital abnormalities tend to be found together, these cases question the notion that intralobar sequestrations only occur secondary to chronic inflammation or infection, and suggest they can be congenital lesions.

Bronchogenic cyst of the lung mimicking a pulmonary hydatid cyst in a child

Lung bronchogenic cyst may be infected and present with symptomatology and chest radiological findings compatible with an infected lung cyst, including pulmonary hydatid cyst. We describe a case of a 5-year-old girl with a symptomatic solitary mass in the right lower lobe that was initially treated as a hydatid cyst. Eventually, a lobectomy was performed, and a final diagnosis done on pathology showed an infected congenital bronchogenic cyst.

Bronchogenic gastric cyst. A case report

A case of congenital bronchogenic cyst in the gastric mucosa is presented. The cyst was lined by pseudostratified epithelium and covered with ciliated cells. Congenital bronchogenic cysts should be differentiated from acquired gastric cysts lined with ciliated metaplastic cells that evolve as a result of environmental factors.

Gross mural cartilage in a congenital bronchogenic cyst: MRI features

An infant who had a cardiac murmur after the delivery was evaluated with echocardiogram. A 1 cm cystic area was incidentally identified in the upper right mediastinum, that was not related with the heart. A 4 x 4.5 x 8 cm cystic mass in the superior mediastinum and lower neck was demonstrated on the magnetic resonance imaging (MRI). At surgery, a small solid structure corresponding to the nodule seen on MRI was identified, which was firm and cartilaginous in nature and attached to the wall of the cyst. Grossly visible cartilage in association with a bronchogenic cyst has not been previously reported. In conclusion, the bronchogenic cysts can have grossly visible cartilage in their wall and extend to extrathoracic spaces in a contiguous fashion, mimicking other entities such as teratomas and cystic lymphangiomas.

Video-assisted thoracoscopic surgery of mediastinal bronchogenic cysts in adults: A single-center experience

BACKGROUND

Mediastinal bronchogenic cysts are rarely diagnosed in adults, hence surgical experience is limited particularly with regard to video-assisted thoracoscopic surgery. In support of the thoracoscopic approach we report our single-center experience in this rare entity.

METHODS

Between June 1995 and December 2002, a nonselected series of 12 consecutive patients presenting with mediastinal bronchogenic cysts underwent video-assisted thoracoscopic surgery. Six cysts (50%) had been diagnosed 2 to 22 years prior, only three of which became symptomatic. In asymptomatic patients (n = 7) surgery was performed because of increasing cyst size (n = 3), patient's request (n = 3), or suspected metastasis (n = 1).

RESULTS

Mediastinal bronchogenic cysts were correctly diagnosed by computed tomography in 83% (10/12) and by magnetic resonance imaging in 100% (9/9). Using a three-trocar technique thoracoscopic surgery was successfully performed in 11 of 12 cases (92%). We noted no signs of acute cyst infection. No serious postoperative complications were observed. In 1 patient conversion to open thoracotomy was necessary due to extensive pleural adhesions. In another case thoracoscopic excision of the cyst wall was incomplete. Patients with thoracoscopic excision were discharged after a median of 5.5 days (range 4 to 14 days). No recurrences or complications were observed during a mean follow-up of 40.5 months.

CONCLUSIONS

Considering the low conversion and complication rate in our series, video-assisted thoracoscopic surgery should be the primary therapeutic choice among adults with symptomatic mediastinal bronchogenic cysts. Surgical intervention in patients with asymptomatic and uncomplicated cysts appears optional.

Mediastinal bronchogenic cyst treated by mediastinoscopic drainage

Bronchogenic cysts are rare congenital anomalies located in the mediastinum and lung parenchyma. We present the clinical findings and describe the mediastinoscopic treatment of a bronchogenic cyst at the subcarinal space in a 50-year-old man. CT revealed a lesion at the subcarinal space with soft tissue density. Initially, mediastinoscopy was performed for diagnostic purposes. Histopathological evaluation of biopsy material taken from the cyst wall confirmed that the lesion was a bronchogenic cyst. The cyst contents were drained and a sclerosant agent was applied to the cyst lumen via the drainage tube. Mediastinoscopy not only provides diagnostic information but can also be used safely in the treatment of anterior bronchogenic cysts in patients not amenable to a second operation.

[Clinical and pathological features of congenital bronchial cyst]

OBJECTIVE

To study the clinical and pathological features of congenital bronchial cysts.

METHODS

The clinical, X-ray, CT and histopathologic manifestations were retrospectively reviewed in 30 patients with congenital bronchial cysts.

RESULTS

There were 23 patients with intrapulmonary bronchogenic cysts, 5 patients with mediastinal bronchogenic cysts, and 2 patients with ectopic bronchogenic cysts. Of the 30 patients, 18 were liquid cysts, 7 air cysts, and 5 multiple pulmonary cysts. Intrapulmonary congenital bronchial cysts were diagnosed always due to infection. Nineteen of 23 patients (83%) presented with cough, sputum production, 2 accompanied by fever, 11 with hemoptysis or blood-stained sputum, 11 with chest pain. The imaging features were "bag included mass", which was characterized by a big bag surrounded by a little soft-tissue, or thin walled cavity, or multiple honeycomb or cystoid circular translucency. Two of 4 patients with mediastinal bronchogenic cysts incidentally discovered on a radiograph obtained for other reasons were almost asymptomatic, 2 presented with dyspnea due to compression of trachea, 1 with dysphagia due to compression of oesophagus. The imaging features included isolated well-defined round shape or ovoid soft-tissue mass with isodensity, and mutual compression between the surrounding organs. Two patients with ectopic bronchogenic cysts were diagnosed due to cystic mass on chest wall. Pseudostratified ciliated columnar epithelium, gland, cartilage, elastic fiber and smooth muscle were all confirmed by light microscopy.

CONCLUSIONS

The main type of congenital bronchial cysts is intrapulmonary bronchogenic cysts. The clinical manifestations are cough, sputum production and hemoptysis, and the imaging feature is "bag included mass" on CT scan. A lining of respiratory epithelium associated with a wall containing glands, cartilage and smooth-muscle is the histopathologic feature for diagnosing congenital bronchial cysts. The optimal treatment is surgical resection.

[Congenital bronchogenic subcutaneous cyst of the back. A case report and review of the literature]

The Authors describe a very rare congenital case of bronchogenic subcutaneous cyst of the scapular region occurring in a 8-year-old girl. Only 8 other cases have been published so far. The cyst was asymptomatic and was surgically removed. It measured 2.3 cm. in diameter. Histologically, the cyst was lined by ciliated columnar pseudostratified epithelium devoid of goblet cells and mucus secreting cells. The epithelium lacked immunoreactivity for estrogen and progesterone receptors. The cyst wall contained smooth muscle bundles, but cartilage was absent. Differential diagnosis with emphasis on cutaneous ciliated cyst (Mullerian cyst) is discussed. It appears conceivable that cutaneous ciliated bronchogenic cysts may show partial or fully developed features indicating their bronchial origin.

Clinics in diagnostic imaging (86). Ruptured bronchogenic cyst

An eight-year-old boy presented with a sudden onset of chest pain. He had been diagnosed to have a left spontaneous pneumothorax. Chest radiographs and computed tomography of the chest showed a thin-walled cyst in the left lower lobe. Thoracotomy and a segmentectomy of the apical segment of the lower lobe was performed, confirming the diagnosis of a ruptured bronchogenic cyst. Imaging findings of various pulmonary cystic lesions in children are discussed.

Pathological analysis of congenital cervical cysts in children: 20 years of experience at Chang Gung Memorial Hospital

BACKGROUND

Congenital cervical cysts are frequently encountered in pediatric populations, and constitute one of the most intriguing areas of pediatric pathology. This report analyzes cervical cysts in Taiwanese children diagnosed at Chang Gung Memorial Hospital (CGMH) over the past 20 years. The pathologic and clinical findings are reviewed.

METHODS

Files on 331 patients under the age of 18 years, with a diagnosis of congenital cervical cyst at CGMH from January 1, 1983 to June 30, 2002, were retrieved from the Department of Pathology. There were 204 boys and 127 girls. We reviewed the histology of all cases and correlated it with clinical information in the medical records.

RESULTS

Thyroglossal duct cysts, the most common congenital neck cyst, accounted for 54.68% of all cases, followed by cystic hygromas (25.08%), branchial cleft cysts (16.31%), bronchogenic cysts (0.91%), and thymic cysts (0.30%). Nine cases (2.72%) remained unclassified.

CONCLUSIONS

This is the largest series regarding pediatric cervical cysts in the literature to date. Thyroglossal duct cysts were the most common congenital cervical cyst encountered. Our experience indicates that each type of cyst has its unique location in the neck and is highly associated with its embryonic origin. Complete and precise clinical information is a prerequisite in order for pathologists to make accurate diagnoses of congenital cervical cysts.

Congenital masses of the lung: prenatal and postnatal imaging evaluation

Congenital masses of the lung are a spectrum of interrelated abnormalities that includes congenital lobar overinflation, bronchogenic cyst, congenital cystic adenomatoid malformation (CCAM) and sequestration. The prenatal and postnatal imaging features of these lesions are reviewed, emphasizing the importance of serial prenatal sonograms and postnatal imaging studies, including radiography and computed tomography. Masses that become inconspicuous, or disappear on serial prenatal sonograms are discussed, as well as the importance of postnatal imaging studies in the evaluation of these lesions. Finally, the management of congenital masses of the lung is reviewed, emphasizing the importance of imaging studies in the preoperative evaluation.

Concurrent cysts of the mediastinum, pleura and neck

A 14-year-old male was found to have a mediastinal mass on chest radiograph. Chest computed tomography scans showed a cystic lesion behind the left main bronchus. Magnetic resonance imaging revealed additional cystic lesions in the left chest and root of the neck. He underwent excision of mediastinal mass and a pleural cyst. The neck lesion was presumed to be a cystic hygroma. Histological examination of the two lesions resected showed them to be a foregut cyst and a benign mesothelial cyst. We know of no other report of concurrent multicystic lesions in the chest and neck and hypothesize that these cysts may have a common embryonic origin.

Carcinoma arising in congenital lung cysts

We report on a patient presenting with a bronchioloalveolar carcinoma fortuitously detected in the wall of a bronchogenic cyst. Evidence suggests that unstable epithelial cells contained within the cyst wall may lead to premalignant proliferation and neoplasia. In the current case, we demonstrated an increased proliferative activity in some areas of the cyst consistent with atypical adenomatous hyperplasia. Hence, we stress the importance of close follow-up of all suspected congenital lung cysts because of their potential malignant degeneration.

Congenital cervical bronchogenic cyst

A bronchogenic cyst is a rare developmental aberration that occurs in the paediatric age group. Over 50 cases of bronchogenic cysts have been reported in the literature. There is still a possibility of clinically misdiagnosing this condition as a more common congenital neck cyst like a branchial cyst. We report here the case of a 12-year-old female presenting with a neck swelling since birth who was diagnosed to have a bronchogenic cyst based on characteristic clinical and histopathological findings.

[Lobar emphysema due to bronchial atresia associated with a bronchogenic cyst]

We report a case of bronchial atresia in the apical segment of right down lobule associated to subcarinal bronchogenic cyst in an eighteen years old patient who consults by long time bronchitis. The thorax X-ray shows an image suggested of mucoid impaction. The respiratory function tests are not essential for the diagnostic. The fiber bronchoscopy is normal and the diagnostic is established by mean image technics (thoracic HR-TC and MR).

Congenital intrapulmonary bronchogenic cyst in the neonate--perinatal management

Approximately 50% of all congenital lung malformations are pulmonary and mediastinal bronchogenic cysts (BC). Therefore, their diagnosis and management is of clinical importance. Usually asymptomatic in the first months of life, bronchogenic cysts are frequently clinically inapparent even adulthood. Early diagnosis and elective surgery can prevent late complications such as pneumothorax, pulmonary hypertension, and recurrent infections; prognosis after surgery is excellent. If mediastinal shifting is present, fetal thoracocentesis is indicated to prevent cardiovascular insufficiency. We report a case of a prenatally diagnosed intrapulmonary BC of the right lung. Following in utero thoracocentesis of the cyst and transient spontaneous regression postnatal onset of severe clinical symptoms due to rapidly developing hyperinflation and mediastinal shifting within the first days of life required early surgical intervention.

Congenital cystic disease of the lung in infants and children (experience with 57 cases)

A retrospective analysis of 57 consecutive cases with congenital cystic disease of the lung admitted to King Faisal Specialist Hospital and Research Center and King Khalid University Hospital, Riyadh, between 1985-1995 is presented. There were 37 congenital lobar emphysema (CLE), 7 cystic adenomatoid malformation (CAM), 8 bronchogenic cyst (BC) and 5 pulmonary sequestrations (PS). There were 39 males and 18 females with ages ranging from 1 day to 5 years. All patients were symptomatic except three. Respiratory distress, repeated chest infections, and cystic changes noted in chest x-ray were the commonest presentation. Five of eight patients with BC presented with symptoms related to pressure effect of the cyst on the surrounding structures, these included bronchiectasis in two patients, bronchopleural fistula in one, pulmonary artery stenosis and bronchomalacia in one, airway obstruction mimicking bronchial asthma in one. Seven patients (12.2%) were treated conservatively, the remaining underwent surgery. Surgery included excision of the bronchogenic cyst and lobectomy for CLE, CAM, and intralobar sequestration. The post-operative course in most cases was uneventful. There were no deaths in this series, and the majority of patients had a satisfactory outcome with follow-up ranging from 1-72 months (mean 24 months). It appears that lobectomy for symptomatic CLE, CAM, and intralobar sequestration and excision for bronchogenic cyst offer the best treatment modality and is well tolerated by pediatric patients. Careful search for associated anomalies is important to obtain better outcome.

Congenital parenchymatous malformations of the lung

Congenital lung malformations, primary and secondary, contribute to an important portion of pediatric thoracic surgery. One purpose of this report is to outline the close relation in terms of embryology and clinical presentation of congenital parenchymatous pulmonary malformations. In a retrospective study we also aim to evaluate our experience with the diagnosis and surgical management of congenital parenchymatous bronchopulmonary malformations and to compare our data with the literature. From January 1979 to December 1996 a series of 48 patients, 30 males (62.5%) and 18 females (37.5%), were operated on for congenital bronchopulmonary malformations. Pulmonary sequestration, bronchogenic cysts, congenital lobar emphysema, and congenital cystic adenomatoid malformation were seen in 16, 13, 5, and 14 patients, respectively. The first clinical symptoms occurred at a mean age of 8.8 years (1 day to 62 years), and the mean age at the time of surgical intervention was 9.3 years (1 day to 62 years). The maximum time between first symptoms and surgical treatment was 27 years. A lobectomy was performed in 22 cases; in the other patients more lung-preserving surgery such as enucleation or sequestrectomy was performed. Only one postoperative death occurred following lobectomy for pulmonary sequestration, and it was due to pulmonary hypoplasia and pulmonary hypertension. Eleven other patients presented with postsurgical complications: pneumothorax (n = 5), pleural effusion (n = 3), prolonged air leak (n = 2), portal vein thrombosis (n = 1), and hemorrhage requiring reintervention (n = 1). We conclude that any thoracic cystic lesion expanding on chest radiography should be an indication for surgical resection, even if asymptomatic, because of the risk of pulmonary compression, infection, or malignant degeneration. In the few cases of a fetal intrathoracic mass, prenatal diagnosis and intrauterine intervention may be indicated, and these indications are also discussed.

Coexisting congenital sublingual dermoid and bronchogenic cyst

A congenital dermoid together with a bronchogenic cyst at the base of the tongue is extremely rare. We describe a 5-year-old boy who presented with an enlarged anterior segment of mandible, slight swelling of the left submandibular region, and a large swelling of the floor of the mouth that was displacing the tongue posteriorly. Both cysts were successfully excised and the boy made an uncomplicated recovery. Occlusion and mastication returned to normal and his speech improved remarkably.

Clinical spectrum of congenital cystic disease of the lung in children

OBJECTIVES

Congenital cystic lesions of the lung are uncommon but share similar embryologic and clinical characteristics. The purpose of this study is to review our institutional experience of congenital cystic lung disease, emphasizing the clinical spectrum of the disease related to age, and present some cases with unusual clinical manifestations.

PATIENTS

Between 1962 and 1996, 26 patients (9 females and 17 males) under 15 years old underwent evaluation and surgical treatment for congenital cystic lung disease. Seven patients were under 1 year old, and 19 were in over 1 year old. There were 13 bronchogenic pulmonary cysts, 6 pulmonary sequestrations, 4 congenital cystic adenomatoid malformations (CCAM), and 3 congenital lobar emphysemas.

RESULTS

All patients under 1 year old showed respiratory distress with mediastinal shift but no episodes of infection. In contrast, 13 of the 19 patients over 1 year old had symptoms of recurrent infection without respiratory distress. Five patients over 1 year old were entirely asymtomatic from birth. There were significant differences (P < 0.05) in the frequencies of respiratory distress and infection between the two groups (chi2-test). Lobectomy was performed in 21 patients, excision in 3 patients, segmentectomy in one patient, and exploration in one patient. There was no incident of postoperative mortality or morbidity except for one patient with CCAM complicated by reexpansion lung edema. Twenty-one patients at long-term follow-up from 2 to 30 years after surgery are doing well with no subsequent limitation of physical activities due to lung resection.

CONCLUSIONS

In patients under 1 year old, cystic lesions were discovered by respiratory distress; and in patients over 1 year old signs of infection were the most important clinical features. Early recognition of these relatively rare congenital cystic lung lesions would lead to the immediate, proper surgical intervention.

[Congenital bronchopulmonary cystic disease]

From September 1989 to December 1994, 12 children with congenital bronchopulmonary cystic disease were operated in the Department of Pediatric Surgery, Santa Maria Hospital. Four cases of bronchogenic cyst (BC), 2 of cystic adenomatoid malformation (CAM), 3 of pulmonary sequestration (PS), and 3 of congenital lobar emphysema (CLE) were found. Age ranged between 9 days and 10 years without predominance of gender. Seven were younger than one year of age, of which 5 were less than 6 months old at the time of surgery. The CAT scan was most useful in the diagnosis and follow-up of these children. The review of these cases helped evaluate our experience in the diagnosis and surgical approach for these congenital malformations. Successful treatment depends on early diagnosis and the planning of therapeutic priorities, based on the embryological and pathophysiological knowledge at these anomalies. The embryological mechanisms implicated in the development are discussed and the results of surgical treatment are presented.

[Use of Tienam in a 50-year old male with respiratory failure caused by multiple congenital bronchogenic cysts infected with bacteria with significant antibiotic resistance]

The paper discusses a case of 50-year-old male admitted to the hospital with symptoms of respiratory failure. The patient had previously been treated for pneumonia. After the admission, control-assisted ventilation was introduced and a swab from endotracheal tube was taken for microbiological examination, as well as pefloxacin, dexamethasone, Ambroxol and heparin treatment was administered. Patients condition improved. After several days respiratory failure intensified, requiring repeated artificial ventilation. According to the obtained antibiogram, Tienam was administered with favourable results. During the therapy with Tienam no side-effects were observed. Based on chest X-ray examination and data from interview, infection of multiple congenital bronchogenic cysts was diagnosed.

Cutaneous bronchogenic cyst: delineation of a poorly recognized lesion

Bronchogenic cyst is a benign congenital developmental abnormality of the embryonic foregut. The most common extrapulmonary location of these lesions is the mediastinum. Over 50 cases of cutaneous bronchogenic cyst were reported in the English literature. Nevertheless, it is poorly recognized by clinicians and is sometimes confused with branchial cyst. In almost all cases the diagnosis is established by histopathologic examination. We report an unusual clinical presentation of bronchogenic cyst in a 4-year-old girl and review the literature. This lesion is four times more common in males than in females. The most common location is the suprasternal notch, followed by the presternal area, neck, and scapula. The characteristic histologic findings are a ciliated pseudostratified epithelial lining with the presence of smooth muscle cells, goblet cells and, less frequently, cartilage. Our review of the clinical and histologic features of all reported cases further delineates this entity and may facilitate its clinical diagnosis. Bronchogenic cyst should be included in the differential diagnosis of congenital cystic and nodular skin lesions on the upper chest, upper back, and neck.

[Progress in the surgical treatment of congenital and acquired broncho-pulmonary pathology]

Surgery is the cornerstone in the management of congenital bronchopulmonary diseases. This term include a wide spectrum of malformative anomalies subdivided clinically into cystic and solid lesions. Bronchogenic cyst (BC), cystic adenomatoid malformation (CAM) and congenital lobar overinflation (CLO) are congenital cystic lesions. Pulmonary sequestration (PS) and pulmonary arteriovenous malformation (PAM) are congenital solid lesions. As a group, congenital bronchopulmonary diseases require removal in order to reduce potentially life-threatening infection and respiratory distress. Bronchopulmonary infections and neoplasms constitutes acquired bronchopulmonary diseases. Improvement in antibiotic therapy has reduced the place of surgery in the current treatment of bronchopulmonary infections. At present, the failure of medical therapy and the appearance of complications are the most common indications for operative treatment. Although these problems are not as common now, at times they required surgical intervention. Finally bronchopulmonary neoplasms are unusual in the pediatric age group. As a result, experience with the diagnosis, management and prognosis is limited. However, the complete surgical resection offers the best chance for survival in the large majority of cases.

Four cases of developmental foregut cysts

Four patients with developmental foregut cysts were seen in the Singapore General Hospital between 1991 and 1994. Three had bronchogenic cysts while one had features consistent with both enteric and bronchogenic origin. Among those patients with bronchogenic cysts, only one was symptomatic, having presented with cough and dysphagia. Two other patients presented incidentally on chest radiographs done for pre-National Service enlistment while one patient was picked up when a repeat chest radiograph was done following a course of antibiotics. The diagnosis of our first patient with the symptomatic bronchogenic cyst was based on barium swallow and a computerised tomographic scan of the thorax. Two patients were diagnosed on histology following open thoracotomy and surgical resection of the cysts to have a bronchogenic and a cyst of mixed origin as described above respectively. The last patient who underwent video-assisted thoracoscopic surgery with resection of the cyst was confirmed histologically to have a bronchogenic cyst.

Congenital mediastinal bronchogenic cyst with malignant transformation: an autopsy report

A rare autopsy case of mediastinal bronchogenic cyst with malignant transformation is presented. The cyst had been located in the anterior mediastinum for at least 28 years in a 52 year old male. Chest X-ray findings showing rapid enlargement of the cyst and biopsy of the spine for lumbago made a clinical diagnosis as suspicious mediastinal cystic teratoma with malignant transformation metastasizing to the spine. Postmortem examination revealed that the cyst was located in the anterior mediastinum extending to the left pulmonary hilum and had no connection with the tracheobronchial tree. The cyst wall consisted of bronchus-like tissue including ciliated epithelium, hyaline cartilage, smooth muscle and mucoserous glands. There were no teratomatous components in the wall. Malignant tumor predominantly consisting of round cells occurred in the thickened cyst wall and grew into the cyst cavity with direct invasion of the lung and metastases to the liver, adrenal glands, bone marrow of the lumbar spine and lymph nodes. An immunohistochemical study showed that the tumor cells frequently expressed cytokeratin, epithelial membrane antigen and carcino-embryonic antigen, occasionally CA19-9, vimentin and neuron-specific enolase. From these findings, the tumor was diagnosed as undifferentiated carcinoma arising in the mediastinal bronchogenic cyst.

Giant bronchogenic cyst presenting as a lobar emphysema in a newborn

Bronchogenic cysts are relatively uncommon congenital lesions. Because of the variability in clinical presentation and the shortcomings of diagnostic procedures, bronchogenic cysts present a diagnostic problem. This report describes a giant bronchogenic cyst that presented as a lobar emphysema in a newborn.