Bronchogenic cyst

Case contributed by Dr Ammar Ashraf

Presentation

Smoker with dry cough for one year. No fever, night sweats, anorexia or weight loss.

Patient Data

Age: 35 years
Gender: Male
X-ray

Sizable well-defined homogeneous non-calcified soft tissue density mass in the subcarinal middle and posterior mediastinum, causing splaying of the carina. Clear both lungs.

CT

A well-defined thin-walled cystic lesion measuring about 5.0 x 5.0 x 5.0 cm is seen in the subcarinal posterior mediastinum. It has an average density of about 25 HU, minimal peripheral enhancement and mild mass effect over the esophagus. No septations, calcifications, or solid component is seen in it.

Postoperative day 1

X-ray

Mild right basal atelectatic changes, surgical emphysema in the soft tissues of the right lateral chest wall and right lower neck and minimal right apical pneumothorax. Right-sided chest tube seen in place. 

5 weeks later

X-ray

Status post excision of subcarinal mediastinal lesion. Post-operative changes have also resolved. 

Well-defined subcarinal posterior mediastinal cystic lesion, which is likely a bronchogenic cyst; possible differential diagnosis includes esophageal duplication cyst and pericardial cyst.

Case Discussion

The patient underwent excision of the sbcarinal mediastinal cystic lesion via video-assisted thoracoscopic surgery (VATS). 

Gross: Specimen consists of multiple fragments of cyst wall measuring in aggregate 3.0 x 2.0 cm and 0.4 cm in thickness. Sectioning shows grey-red soft hemorrhagic cut surface.

Microscopy: Sections show cyst wall lined by ciliated pseudo-stratified columnar to cuboidal cells and within the wall there are scattered mucinous glands, fibrosis, smooth muscles and scattered lymphoid follicles.   

Diagnosis: Bronchogenic cyst.

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