Intramural esophageal bronchogenic cysts

Bronchogenic cysts are most frequently located in the middle mediastinum near the carina. Esophageal bronchogenic cysts are extremely rare. An intramural esophageal bronchogenic cyst was successfully resected from a 51-year-old man.     

食管壁内支气管囊肿的临床分析

目的探讨食管壁内支气管囊肿的临床特征和诊断,总结经验,以提高外科诊治能力。方法回顾性分析本院1990年至2008年收治的9例食管壁内支气管囊肿的临床资料,并复习文献。结果手术探查见囊肿均位于食道肌层内或起源于肌层内;病理诊断囊壁为假复层柱状纤毛上皮结构,所有病例均得到确诊,术后均痊愈出院。结论食管壁内支气管囊肿术前确诊困难,多通过手术和病理得到确诊。术前食管超声内镜有助于提高对本病的诊断率,胸腔镜辅助下的微创手术和内镜黏膜下囊肿剥离术具有独到的优势。     

“Bronchogenic cyst impersonating a pericardial lesion”: A case report

A 32-year-old female presented with palpitations and chest discomfort. The patient had a history of pericardiotomy due to pericardial effusion. Multimodal imaging, including echocardiography, cardiac magnetic resonance (CMR), and coronary computed tomography angiography (CCTA) showed a single mass in the pericardium as the cause of the symptoms. Furthermore, its location and potential complications were accurately defined. The patient underwent a successful surgical resection of the pericardial cyst, microscopic histopathological examination was compatible with a bronchogenic cyst, a very rare congenital malformation. The article discusses the rarity of bronchogenic cysts in the pericardium and the importance of accurate diagnosis and appropriate treatment.     

Multiple Bronchogenic Cysts of the Esophagus

Esophageal location of bronchogenic cysts is rare especially if two cysts are present. We report such a case in a girl 17 years old who had several intramural esophageal smooth defects which looked like multiple leiomyomatosis of the esophagus. At surgery there were two bronchogenic cysts arising in the wall of the esophagus and lying on each side of the azygos arch.
Bronchogenic cysts of the esophagus are rare, especially if two cysts are present.     

异位支气管囊肿的诊断和外科治疗

目的探讨异位支气管囊肿的临床病理特征和诊断,提高外科治疗水平。方法回顾分析我院1990年1月至2008年10月收治的4例异位支气管囊肿的相关临床资料,并进行文献复习。结果4例异位支气管囊肿中1例为腹膜后支气管囊肿伴慢性炎症,右额叶支气管囊肿1例,前胸壁皮下支气管囊肿1例和1例椎管内支气管囊肿,术前全部误诊,4例通过手术完整切除,病理检查确诊为支气管囊肿,术后无复发。结论异位支气管囊肿临床罕见,诊断主要依据影像学检查和病理检查,治疗首选外科手术切除,完整切除后无复发。     

Infected bronchogenic cyst causing dysphagia and retrosternal pain

Bronchogenic cysts are congenital. They are typically discovered in infancy or early childhood. Secondary infection of the cyst is uncommon. We present the case of a 17‐year‐old female who presented to the emergency department with intermediate onset of upper abdominal, and retrosternal chest pain and fever. Subsequent X‐ray and computerised tomography scan showed a bronchogenic cyst. The patient underwent subacute thoracotomy where a bronchogenic cyst filled with pus was located and excised. Bronchogenic cysts can be a rare cause of retrosternal pain. Please cite this paper as: Søndergaard EB, Pedersen JH and Kleive D. Infected bronchogenic cyst causing dysphagia and retrosternal pain. Clin Respir J 2013; 7: e1–e2.     

Esophageal bronchogenic cyst: a rare entity

BACKGROUND/AIMS: Bronchogenic cysts are congenital lesions of foregut origin, usually found in intrapulmonary or mediastinal locations. However, an esophageal bronchogenic cyst is an uncommon occurrence. The definitive diagnosis is based on histological findings after extirpation of the cyst. Surgical excision of bronchogenic cysts is considered appropriate because of the high complication rates of subsequent infection, rupture, hemorrhage, and malignant degeneration if left untreated. RESULTS: A 42-year-old man presented with a two-year history of progressive dysphagia. An esophageal bronchogenic cyst was evidenced by esophagography, Computed tomography, magnetic resonance imaging, and endoscopic ultrasound, followed by confirmation with surgical exploration. CONCLUSION: Esophageal bronchogenic cysts should be included in the differential diagnosis of a mediastinal tumor, especially when the tumor is within or near the tracheobronchial tube, even though it is a rare condition.     

Unusual case of stridor and wheeze in an infant: tracheal bronchogenic cyst

Bronchogenic cysts are congenital anomalies that represent aberrant development of the foregut. Bronchogenic cysts in the mediastinum have been documented in both children and adults, but only one case of tracheal bronchogenic cyst in an infant was found in the literature. We report on a case of an infant with wheeze, stridor, and retractions, caused by a midtracheal bronchogenic cyst. This entity, with its unusual location, should be considered in the differential diagnosis of respiratory distress, cyanotic spells, wheezing, and stridor in infants.     

Posterior Mediastinal Bronchogenic Cyst Compressing Left Atrium

The echocardiographic literature contains exceedingly few reports of mediastinal bronchogenic cyst; in most published cases of this entity, the cysts were imaged by computed tomography or magnetic resonance imaging. Because mediastinal bronchogenic cyst is little known as a cause of cardiorespiratory symptoms, we report such a case.     

Endoscopic resection in the treatment of intramural esophageal bronchogenic cysts: A retrospective analysis of 17 cases

BackgroundIntramural esophageal bronchogenic cysts (EBCs) are rare congenital malformations. Differences in reports on the clinical features of intramural EBCs and some controversies about the treatment strategy for intramural EBCs exist.ObjectivesTo investigate the clinical characteristics of intramural EBCs and evaluate the safety and efficacy of endoscopic resection.MethodsThe clinical and endoscopic features, endoscopic resection treatment, postoperative adverse events, and follow-up results of 17 patients with intramural EBCs were retrospectively studied.ResultsIntramural EBCs exhibited male predominance with a male/female ratio of 58.8% (10/7) and were predominantly found in the distal esophagus. Approximately 94.1% of patients presented with gastrointestinal symptoms. All lesions were protruding masses covered by intact mucosal epithelium. The morphologies of intramural EBCs were diverse under white light endoscopy. On endoscopic ultrasonography, intramural EBCs presented as homogeneous or inhomogeneous hypoechoic or anechoic lesions. Eleven lesions originated from the muscularis propria, which underwent submucosal tunnel endoscopic resection (STER), and six lesions were from the submucosa, which underwent endoscopic submucosal dissection (ESD). Approximately 88.2% of patients underwent complete endoscopic resection. No serious pneumothorax, bleeding, pleural effusion, esophagotracheal fistula, or other adverse events occurred in all patients after endoscopic resection, and no cyst recurrence, metastasis, or esophageal scar stenosis was observed during the follow-up period.ConclusionsIntramural EBCs can be treated by digestive endoscopic surgery. STER and ESD are safe, effective, and minimally invasive resection methods.     

Esophageal intramural pseudodiverticulosis associated with esophageal perforation

We report a rare case of esophageal intramural pseudodiverticulosis with lower esophageal stricture which perforated into the peritoneal cavity after the patient vomited. A 61-year-old man was admitted with severe chest and epigastric pain after dysphagia and vomiting. Under a diagnosis of upper gastrointestinal perforation, laparotomy was performed. The anterior wall of the abdominal esophagus was found to have ruptured, and proximal gastrectomy with abdominal esophagectomy was performed. His-tological examination revealed esophageal intramural pseudodiverticulosis with esophageal stricture distal to the site of rupture, and postoperative endoscopy showed diffuse pseudodiverticulosis in the remaining esophagus. The patient is free of symptoms 5 years after the surgery. This case suggests that careful treatment may be indicated in patients with esophageal intramural pseudodiverticulosis with stricture and elevated intraluminal pressure, to minimize the possibility of severe complications such as esophageal perforation. Received: June 7, 1999 / Accepted: January 28, 2000     

A paraesophageal bronchogenic cyst with esophageal communication

Paraesophageal bronchogenic cysts are a rare developmental anomaly of the upper digestive tract. Although often asymptomatic, their growth can cause severe symptoms and complications because of the location. The diagnosis is difficult and is mostly by histopathologic findings after extirpation of the cyst. The authors present a case of a paraesophageal bronchogenic cyst, of typical histologic structure (ciliated epithelium and hyaline cartilage) connected with the esophageal lumen by a narrow canal composed of stratified squamous epithelium. According to the available literature, only three cases of bronchogenic paraesophageal cysts with esophageal communication have been reported.     

Esophageal duplication cysts: endosonographic findings in asymptomatic patients

Esophageal duplication cysts are rare inherited lesions usually diagnosed in early childhood. Most of them are found in the mediastinum and manifest themselves as separate masses along or in continuity with the native esophagus. Their prevalence remains unknown and they are treated either surgically or endoscopically. In this report we describe a series of four adult patients in whom esophageal duplication cysts were localised intramurally as masses pressing on the esophageal lumen and who were diagnosed with endoscopic ultrasonography. All patients were initially referred to other centres for upper gastroduodenoscopy due to non-specific dyspeptic symptoms. After finding suspicious lesions in the esophagus their endoscopists referred them for endoscopic ultrasound examination at our centre. In two of the cases lesions mimicked esophageal varices and the other two submucosal tumours. In all four patients endoscopic ultrasonography has shown esophageal duplication cysts. Patients had no symptoms suggesting disease of the esophagus and required no treatment. As the true prevalence of esophageal cysts is unknown, it is very likely that in many patients, like in these four described by us, they may cause no symptoms, remain undetected and require no intervention. Increasing availability of new diagnostic modalities such as endoscopic ultrasonography may change the current view regarding the prevalence of esophageal duplication cysts and prove that they may, in fact, not be such rare findings.     

Esophageal duplication cyst continuously extending into the peritoneal cavity on the proximal portion of the stomach

Although bronchogenic or esophageal duplication cysts are foregut-derived developmental anomalies most commonly encountered in the mediastinum and rarely in the abdomen, a cyst continuously extending into the abdomen via the esophageal hiatus has not been reported previously. We report a case of esophageal duplication cyst that occurred in the distal esophagus and extended continuously into the proximal portion of the stomach via the esophageal hiatus. A 62-year-old Japanese man was admitted to a local hospital complaining of dysphagia and upper abdominal pain. Abdominal ultrasound and CT scan revealed a cystic mass dorsal to the lateral segment of the liver that extended continuously into the mediastinum via the hiatus. The upper gastrointestinal series and endoscopic examination revealed extramural compression of the distal esophagus without mucosal lesions. Resection of the cystic lesion was performed by thoracotomy followed by laparotomy. The upper part of the cyst originated in the submucosal layer, extending into the muscularis propria of the distal esophagus. Histology of the resected specimen indicated that the cystic wall was composed of two smooth muscle layers and that the inner cystic wall was lined with pseudostratified columnar ciliated and/or squamous epithelium associated without cartilage or respiratory gland, indicating esophageal differentiation. These histological characteristics indicated that the cyst was an esophageal duplication cyst, rather than a bronchogenic cyst. This is the first case of a large esophageal duplication cyst of the distal esophagus continuously extending into the abdomen via the esophageal hiatus. The atypical location of this esophageal duplication cyst provides an insight into the pathogenesis of esophageal duplication cysts.     

A rare case of circumferential intramural dissection of the thoracic esophagus

Esophageal intramural dissection is a rare disease, and whole thoracic esophageal intramural dissection is extremely rare. We report a case of circumferential intramural dissection of the thoracic esophagus, which occurred between the submucosal layer and the muscularis propria layer, with inflammation in the false lumen mimicking esophageal mediastinal fistula in the endoscopic view. The diagnosis was finally confirmed at operation and cured by thoracic esophagectomy.     

Subdiaphragmatic bronchogenic cyst of the esophagus masquerading as a metastatic lymph node of coexisting advanced gastric cancer

Esophageal bronchogenic cysts are rare bronchopulmonary foregut malformations, and those located in the abdominal cavity are particularly rare. Esophageal cysts are typically found incidentally; an exact preoperative diagnosis of bronchogenic cyst is difficult, and surgical resection is generally recommended. Here, we report a case in which a subdiaphragmatic bronchogenic cyst of the esophagus coexisted with advanced gastric cancer. A 44-year-old man was referred for the treatment of gastric cancer. A preoperative examination revealed a mass on the right side of the esophagogastric junction that was preoperatively diagnosed as a metastatic lymph node. Intraoperative exploration revealed that the mass had protruded from the abdominal esophageal wall, and was diagnosed as a cyst originating from the subdiaphragmatic esophagus. The cyst was completely resected with the whole stomach and abdominal esophagus. The histopathological findings of the cyst were specific for a bronchogenic origin. The patient has not shown any signs of disease recurrence.     

Intrapericardial bronchogenic cyst adherent to ascending aorta in young patient

Bronchogenic cysts arise from an abnormal budding of the ventral diverticulum of the foregut or the thracheobronchial tree during embryogenesis. An intrapericardial location is an extremely rare finding. Symptoms are related to cardiac structure compression, but in most case they remain asymptomatic. We present a case of intrapericardial bronchogenic cyst in a young patient, resected entirely with repair of right lateral proximal ascending aorta with PTFE graft.     

Clinical spectrum of mediastinal cysts

OBJECTIVES: Congenital cysts of the mediastinum are an uncommon but important diagnostic group, representing 12 to 30% of all mediastinal masses. The purpose of this study was to review our institutional experience with congenital cysts of the mediastinum, emphasizing the clinical spectrum of the disease. DESIGN: Retrospective study. OBJECTIVES: University hospital unit of general thoracic surgery. METHODS: We retrospectively reviewed the records of 105 patients with cysts of the mediastinum (50 male and 55 female patients) who comprised 13.0% of mediastinal masses over the past 50 years. RESULTS: There were 10 pediatric patients (< 15 years old) and 95 adult patients. The prevalence of cysts in the adult populations was higher than that in children (14.1% vs 7.7%, p < 0.05). There were 47 bronchogenic cysts, 30 thymic cysts, 12 pericardial cysts, 7 pleural cysts, 4 esophageal duplications, 2 meningoceles, 1 thoracic duct cyst, and 2 others. MRI has become a useful tool for providing supplemental data in combination with CT. Overall, 38 patients (36.2%) with mediastinal cysts were symptomatic, including 39.2% with bronchogenic/esophageal cysts, 40% with thymic cysts, and 15.8% with pericardial/pleural cysts. One hundred patients had complete resection of their masses, 3 patients with pericardial diverticulum received a thoracoscopic fenestration without mortality, and 2 patients refused surgery. CONCLUSION: Early recognition of these relatively rare lesions would lead to immediate and appropriate surgical intervention. Early surgical intervention is also important because definitive histologic diagnosis can only be established by means of surgical extirpation.     

Imaging features of ciliated hepatic foregut cyst

Ciliated hepatic foregut cyst (CHFC) is a very rare cystic lesion of the liver that is histologically similar to bronchogenic cyst. We report one case of CHFC that was hard to distinguish from solid-cystic neoplasm in imaging features. Magnetic resonance imaging was helpful in differentiating these cysts from other lesions.     

The Endoscopy-Guided Plan of Radiotherapy for Detecting Esophageal Cancer Using Lugol Staining

Abstract: The Lugol staining method has recently come to play an important role in the detection of superficial esophageal cancers which are extremely difficult to detect using only a barium double-contrasted esophagogram and/or a conventional esophagoscopy. We have therefore tested the endoscopy-guided treatment by radiotherapy using Lugol stainings as a technique for detecting 8 lesions of esophageal cancers in 5 patients. This method was found to be useful for the detection of small intraepithelial lesions, such as intramural metastasis or multiple origin cancers. It is also useful in projecting the lesions accurately on the surface of the body of the patient and planning the radiotherapeutic treatment of the lesions. Additionally, it has been found useful in determining the definite shape of superficial malignant lesions in the evaluation of biopsy specimens taken from the border of the non-stained regions.