Video-assisted thoracoscopic resection of a bronchogenic esophageal cyst

Bronchogenic cysts are lesions of congenital origin derived from the primitive foregut. The usual presentation of bronchogenic cyst in the mediastinum is related to cyst infection or adjacent organs compression. A case of a bronchogenic esophageal cyst presenting with progressive dysphagia in a 46-year-old man is described. A video-assisted thoracoscopic excision was performed successfully. Details of the procedure are discussed.     

Recurrent bronchogenic cyst causing recurrent laryngeal nerve palsy.

A case of a 50-year-old male who developed left recurrent laryngeal nerve palsy due to a bronchogenic cyst is presented. The bronchogenic cyst recurred following incomplete excision and multiple attempts at percutaneous aspiration. Recurrent laryngeal nerve palsy is an unusual complication of bronchogenic cysts. This case highlights the need for complete excision of these cysts and the lack of efficacy of cyst aspiration.     

Mediastinal bronchogenic cyst manifesting as a catastrophic myocardial infarction

Congenital bronchogenic cysts of the lung and mediastinum develop from the ventral foregut during embryogenesis. These cysts are often incidental radiologic findings in adults, but patients can be seen with symptoms of chest pain, cough, dyspnea, or any combination of these. Acute presentations are unusual and have rarely been reported. We present the unique case of a 36-year-old man seen with an acute coronary syndrome and sudden hemodynamic collapse. The patient sustained a massive and ultimately fatal myocardial infarction, compression of the left main coronary artery by a bronchogenic cyst was demonstrated at postmortem examination. If detected, bronchogenic cysts should be surgically excised to limit associated morbidity and mortality.     

An intrapericardial bronchogenic cyst

Bronchogenic cysts arise from an abnormal budding of the ventral diverticulum of the foregut or the tracheobronchial tree during embryogenesis. Rarely they develop within the pericardium. Symptoms of intrapericardial bronchogenic cysts such as chest pain, shortness of breath and arrhythmias can vary according to the location of the cyst, its size and compression of heart and vessels. In this case report we present a young women in whom the diagnosis of an intrapericardial bronchogenic cyst was made by echocardiography and later was approved intraoperatively.     

Bronchogenic cysts above and below the diaphragm: report of eight cases

Bronchogenic cysts are developmental foregut anomalies usually located within the mediastinum. Although typically asymptomatic, infection or compression of adjacent structures may become prominent. Surgical excision is recommended to establish diagnosis, alleviate symptoms if present, and prevent future complications. We report our recent experience with bronchogenic cysts including 7 located within the mediastinum and a rare instance of a cyst below the diaphragm.     

Recurrent bronchogenic cyst. An argument for complete surgical excision

A case of a recurrent bronchogenic cyst in a 42-year-old woman 25 years after original resection led to a review of the therapeutic modalities for the management of bronchogenic cysts. Recurrence of bronchogenic cysts is a reason for complete surgical excision of symptomatic bronchogenic cysts at initial presentation. If either asymptomatic or symptomatic bronchogenic cysts are drained or partially excised, long-term follow-up is indicated to detect recurrence.     

Preoperative diagnosis of a paraesophageal bronchogenic cyst using endosonography

Preoperative diagnosis of paraesophageal bronchogenic cysts is difficult, and its management remains controversial. We describe the case of an incidental paraesophageal bronchogenic cyst, suspected preoperatively with endoscopic ultrasound and established intraoperatively by thoracoscopic inspection. Surgical treatment was achieved by cyst excision using a needlescopic technique. Endoscopic ultrasound seems to be the preoperative diagnostic test of choice for paraesophageal bronchogenic cysts.     

Bronchogenic cyst of the stomach treated by surgical resection

Bronchogenic cysts are congenital cystic lesions caused by abnormal budding of the primitive tracheobronchial tube. Most bronchogenic cysts are found in the mediastinum, whereas abdominal bronchogenic cysts are rare with only 39 cases reported in the literature to date. The indication of surgical intervention is still controversial in previous studies. In the present study, we report a case of a bronchogenic cyst of the stomach in an adult who was treated by wedge excision.     

Life threatening complications caused by bronchogenic and oesophageal duplication cysts in a child

An 11-year-old girl presented with severe respiratory distress, fever and septic manifestations. Computed tomography scan (CT) of the chest showed 2 separate superior and posterior mediastinal cysts, the upper one causing severe extrinsic compression of the trachea, and the oesophagus, while the lower cyst was at the subcarinal region compressing the 2 major bronchi. Emergency thoracotomy was performed permitting complete resection of intra-mural oesophageal enteric cyst, and a subcarinal bronchogenic cyst. The postoperative course was uneventful.     

Unusual presentation of a cutaneous bronchogenic cyst in an asymptomatic neonate

Cutaneous presentations of bronchogenic cysts are rare in all age groups. Previous reports of cutaneous manifestations of bronchogenic cysts have been described as nodular, adherent masses, most frequently with a suprasternal location. We report a unique presentation of an infant with a pedunculated, anterior chest wall mass, which was identified as a bronchogenic cyst.     

Bronchopulmonary foregut malformation: a large bronchogenic cyst communicating with an esophageal duplication cyst

A 1-year-old boy with a bronchopulmonary foregut malformation presented with a large mediastinal bronchogenic cyst associated with pulmonary sequestration, a cervical esophageal duplication cyst, a bronchial communication between these cysts, and 2 small bronchogenic cysts around the communication. These lesions were resected followed by an uneventful recovery. J Pediatr Surg 38:E2.     

Intra-esophageal rupture of a bronchogenic cyst

Bronchogenic cysts usually are an asymptomatic disease and present as an incidental finding in the chest X-rays. They require a complete and early surgical excision to prevent complications and recurrences. We report a rare case of a voluminous symptomatic para-esophageal bronchogenic cyst complicated by an esophageal fistula. The initial video-assisted thoracoscopic surgery excision of the cyst was converted in open thoracotomy to suture the esophagus and interpose omentum. Previously, only four cases of para-esophageal bronchogenic cysts with esophageal communication have been reported.     

腹膜后异位支气管囊肿致左肾积水1例及文献复习

目的：探讨腹膜后异位支气管囊肿的诊断及治疗.方法：回顾性分析异位支气管囊肿致左肾积水1例,用关键词支气管囊肿检索Medline及CBM数据库中相关文献,进行复习.结果：本例术前检查提示左侧肾积水,左输尿管上段狭窄,梗阻部位有实性占位.行后腹腔镜探查术,左侧输尿管被实性肿物及纤维条索压迫,予以切除并松解输尿管,病理证实为异位支气管囊肿.随访3个月,超声示左肾积水较前好转.结论：腹膜后异位支气管囊肿术前无特异性影像学检查,可行后腹腔镜探查术明确诊断及治疗并发症.     

Bronchioloalveolar carcinoma arising in a bronchogenic cyst

We report the case of a 37-year-old woman with a radiographically cystic lung lesion. Lobectomy was performed. Histopathologic examination showed a bronchioloalveolar carcinoma arising in a bronchogenic cyst. This suggests that epithelial cells of bronchogenic cysts can undergo malignant transformation. It may be prudent to recommend complete resection of any bronchogenic cyst.     

Excision of bronchogenic cysts in children using an ultrathin fibreoptic bronchoscope

Purpose

We report the use of an ultrathin fibreoptic bronchoscope (Olympus N20: external diameter: 2.2 mm) as the means of airway endoscopic monitoring during anaesthesia for the excision of mediastinal bronchogenic cysts in two young children.

Clinical features

The first, a four-month old boy, presented with stridor and wheezing due to a subcarinal bronchogenic cyst compressing the two main bronchi. The second, an eight-day-old girl whose trachea was intubated, presented with respiratory noise in relation to a bronchogenic cyst compressing the end of the trachea. In both cases, airway endoscopy was performed during anaesthesia with the ultra thin fibreoptic bronchoscope. Endoscopie monitoring allowed, first, a good evaluation of the degree of cyst compression on the airways. Second, the endotracheal tube could be positioned or repositioned with precision in order to avoid severe compression or spilling of liquid into the airways and to allow protection of the suture. Finally, video transmission helped the surgeon to visualize the surgical repair from the inside.

Conclusion

When added to the classical monitoring using SpO₂,PetCO₂ and airway pressure, peroperative endoscopie control provides complementary information which can help to detect possible complications more rapidly. This technique could be extended to all airway surgery on very young children.     

Thoracoscopic resection of foregut duplication cysts

Background: Foregut duplications are rare entities that include both esophageal and bronchogenic cysts. The diagnosis of foregut duplication cyst is made most often from an incidental finding on chest radiograph, or due to respiratory compromise due to mass effect or infection. Treatment consists of complete resection. Recurrences are associated with incomplete resection. Six cases of foregut duplication cysts are presented that were resected thoracoscopically. Materials and Methods: From May 1998 to April 2003, six patients underwent thoracoscopy for resection of foregut duplication cyst. One patient required conversion to open thoracotomy due to esophageal perforation. The distribution of cysts was 4 on the left and 2 on the right; all procedures were performed with three or four ports. Single lung ventilation was used in three patients. The masses were removed via a port site after intrathoracic decompression. Chest tubes were placed in all patients, and most were removed within 12 hours. Results: Five of six cases underwent successful thoracoscopic resection. Pathology demonstrated esophageal duplication cyst in three patients and bronchogenic cyst in the other three patients. Average hospital stay was 5.5 days. Complications included aspiration pneumonia and chest tube dislodgment. There were no deaths, and no recurrences. Conclusion: Thoracoscopic resection is a safe and effective method of treating foregut duplications. Outcomes have been good with little short-term morbidity and no mortality. Morbidity and cosmesis are improved by avoiding thoracotomy. Thoracoscopic resection should be considered the first-line therapy for these benign masses.     

Asymptomatic bronchogenic cysts: what is the best management?

The management of patients with uncomplicated bronchogenic cysts has evolved over the last decade with the development of more precise diagnostic techniques and a better understanding of the variable natural history of these lesions. Although an aggressive surgical approach is still indicated for infants and children, it is acceptable to treat asymptomatic bronchogenic cysts in adults in a conservative manner. Observation alone may be indicated for small, classic, asymptomatic cysts. The use of mediastinoscopy or percutaneous or transbronchial needle techniques for carinal or paratracheal cysts offers the option of fluid aspiration or wall biopsy, thus avoiding thoracotomy. An air-fluid level in the cyst, the presence of malignant cells in the aspirate or biopsy, the development of symptoms, or enlargement or recurrence of the cyst on follow-up examination mandates complete surgical removal at thoracotomy. This is also indicated for intraparenchymal bronchogenic cysts, which are more prone to bronchial communication and infectious complications and for which the distinction from a carcinoma with a cystic component may be difficult.     

呼吸系统外支气管囊肿20例外科治疗

目的探讨发生于呼吸系统外器官的支气管囊肿的临床特点及外科治疗方式。方法回顾性分析我院2002年1月一2013年3月间收治的20例呼吸系统外支气管囊肿患者的临床资料,总结其临床症状、影像学特征及手术方式。结果20例呼吸系统外支气管囊肿,位于前纵隔15例,食管壁内5例。术前均未能明确诊断,术后由病理确诊。就诊时有症状14例（70％）。15例前纵隔支气管囊肿均行完整肿物摘除术,其中7例胸腔镜手术,1例因胸腔闭锁而中转开胸,1例术后出现液气胸、肺不张。5例食管壁内支气管囊肿均开胸切除,其中1例拟采用胸腔镜手术,因无法摘除中转开胸,3例完全剥除囊肿,另2例分别行部分剥除和食管胃部分切除。全组病例均痊愈出院。术后平均随访54（4—122）月未见复发。结论呼吸系统外的支气管囊肿因其位置特殊及临床表现多样,术前诊断较为困难,应通过综合多种影像检查来诊断。治疗上应根据囊肿的情况灵活选择手术方式,前纵隔支气管囊肿建议行胸腔镜下切除,食管壁内支气管囊肿则选择开胸手术。     

Mediastinal bronchogenic cyst presenting with pericardial effusion

We report a case of a 58-year-old woman who had a bronchogenic cyst presenting with pericardial effusion. Initially, the effusion had disappeared prior to resection of the cyst, but it reappeared with additional symptoms. Resection of the bronchogenic cyst resulted in complete resolution of the pericardial effusion and additional symptoms such as progressive dyspnea and chest pain. Application of surgical treatment for asymptomatic cysts in adults remains controversial, but we recommend that mediastinal cysts which present with any symptoms should be resected at the time of their discovery, even though the symptoms disappeared for a while.     

Unusual presentation of a large tension bronchogenic cyst in an adult.

A routine chest radiograph in a 20 year old man revealed a giant air filled cavity of the left hemithorax under tension. At thoracotomy a large left lower lobe intraparenchymal cyst required lobectomy and the pathological findings were consistent with a bronchogenic cyst. Although tension bronchogenic cysts are common in infants, this case demonstrates their unusual presentation in an adult.