Presentation
Three day history of flu-like symptoms, with rapid deterioration in shortness of breath and desaturation in the A&E department. Saturations 92% on high flow oxygen and unable to lie flat. Previously fit and well. PMH: Normal vaginal delivery healthy baby 18 month prior to this presentation.
Patient Data
There is splaying of the carina with a large subcarinal mass demonstrated. Prominent pulmonary vasculature at the hila and retrocardiac opacification / patchy consolidation is also demonstrated.
Large homogenous mass within the middle mediastinum with gross mass effect on adjacent structures. Hounsfield units measure 40-50 on this contrast enhance study. The left atrium is slit like and the right main pulmonary artery is significantly displaced.
Bilateral lung opacities with septal thickening most apparent within the left lower lobe. Images are significantly degraded and demonstrate how acutely unwell this patient is.
Operative findings confirmed a large bronchogenic cyst containing 1500ml of dark straw colored fluid. Microbiology MC&S did not confirm infection within. The cyst was marsupulised at surgery.
Case Discussion
A dramatic presentation of a bronchogenic cyst with cardio-respiratory compromise.
Correctly identifying the diagnosis in such cases is vital.
Describing the anatomy, relation, and effect on the heart / physiology as well as the homogeneous appearance of the mediastinal mass enabled rapid transfer to thoracic surgery and a positive outcome here.