BRONCHOGENIC CYSTS

Bronchogenic cysts (BC), first described in 1911, are benign congenital lesions of the respiratory tract that have the potential to develop complications creating a dilemma in diagnosis and treatment. BC are commonly located in the mediastinum (2/3) or lung parenchyma (1/3) arising from anomalous budding along the primitive tracheobronchial tube (foregut duplication errors). Other atypical locations are cervical, subcutaneous, paravertebral, etc. Contain mucoid material lined with ciliated columnar epithelium (bronchial glands, smooth muscle, cartilage) not communicating with the respiratory tract. Clinical presentation may range from prenatal diagnosis, asymptomatic (1/3) lesions identified during routine work-up to symptomatic (2/3) cases. Infants may show respiratory distress: cough, dyspnea, cyanosis, hemoptysis or dysphagia. Older children present with chest pain, non-productive cough or pulmonary infection. Diagnosis relies on chest films and CT-Scan. Bronchoscopy and barium swallow are not very useful. Infection, hemorrhage, erosion, malignant potential and expansion mandate surgical management consisting of thoracotomy with excision of the lesion if mediastinal in location, and segmentectomy or lobectomy for intraparenchymal cysts. Marsupialization is associated with recurrence.