대한흉부영상의학회 Weekly Chest Cases

Case No : 1068 Date 2018-04-16

Courtesy of Moon Young Kim, MD., Ye Ra Choi, MD., Kwang Nam Jin, MD. / SMG-SNU Boramae Medical Center
Age/Sex 28 / M
Chief ComplaintSubacute epigastric pain

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Diagnosis With Brief Discussion

Diagnosis: Bronchogenic cyst filled with a large amount of hematoma
Radiologic Findings: Fig 1. Chest PA shows a right retrocardiac mass-like opacity.
Figs 2-4. Mediastinal window setting of the chest CT scan shows a non-enhancing well-defined long tubular mediastinal mass with heterogeneous attenuation.

On the gross pathology, the excision specimens marked with mediastinal mass consist of a cyst with its contents. The cyst with smooth wall was filled with clotted material. There was no solid proliferation in the cystic wall. On microscopic pathology, benign cystic lesion lined by respiratory epithelium with hematoma mainly, chronic active inflammation, and dystrophic calcification, suggestive of bronchogenic cyst.
Brief Review: Bronchogenic cyst results from an anomalous supernumerary budding of the ventral or tracheal diverticulum of the foregut during the sixth week of gestation and is thus part of the spectrum of bronchopulmonary foregut malformations.
The most frequent location is mediastinal and subcarinal region. Bronchogenic cysts usually contact the carina or main bronchi but may be seen anywhere along the course of the trachea and larger airways.
Bronchogenic cysts vary in size and may be quite large. They are usually discrete and unilocular. The cyst contents usually consist of thick mucoid material. The cysts can grow very large without causing symptoms but may compress surrounding structures, particularly the airway, and give rise to symptoms .In rare cases, they can become infected or hemorrhage may occur into the cyst. These complications may be life threatening, particularly in infants and young children
Differential diagnosis for uncomplicated cysts includes congenital cysts and malformations, such as pericardial cyst, cystic hygroma, lymphangioma, neurenteric cyst, and esophageal duplication cyst. If the cysts are complicated (with infection or hemorrhage), they may show high attenuation and/or enhancing thick wall. In those cases, the lesions might mimic abscess, necrotic lymph node, or tumorous condition.
Surgery may be considered as the treatment of choice even when the cyst is asymptomatic, since complications are not uncommon and definitive diagnosis can be established only with surgical specimens.
References: 1. Smitha S, Raghuram P. High atennuation bronchogenic cyst in the posterior mediastinum. Indian J Radiol Imaging 2004;14:391-4
2. Sarper A, Ayten A, Golbasi I, Demircan A, Isin E. Bronchogenic Cyst. Texas Heart Institute Journal. 2003;30(2):105-108.
Keywords: Mediastinum, Bronchogenic Cyst ,

No. of Applicants : 122

▶ Correct Answer : 1/122, 0.8%

- Other , Korea (South) HAYEON LEE

▶ Correct Answer as Differential Diagnosis : 2/122, 1.6%

- , Japan NAOMI YUASA
- , Japan YUMI MAEHARA

▶ Semi-Correct Answer : 16/122, 13.1%

- Chonbuk National University Hospital , Korea (South) YOUNGKWANG LEE
- , United States MAANSI P
- Tehran University of Medical Sciences , Iran ali mahdavi
- Onomichi municipal hospital , Japan Hirofumi Mifune
- , Korea (South) JANG SEONG WON
- Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
- MD , India DEEPANDER SINGH RATHORE
- Chonnam National University Hwasun Hospital , Korea (South) JONG EUN LEE
- Chonnam National University Hwasun Hospital , Korea (South) GANG SEONG WOONG
- Samsung Medical Center , Korea (South) MIN YEONG KIM
- Seoul National University Hospital , Korea (South) Ju Gang Nam
- , Korea (South) HYO JAE LEE
- IRSA LA ROCHEELLE , France JEAN LUC BIGOT
- Ajou University Hospital , Korea (South) Taeyang Ha

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1068 Date 2018-04-16

Discussion

No. of Applicants : 122