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Weekly Chest CasesArchive of Old Cases

Case No : 706 Date 2011-05-09

  • Courtesy of Chaehun Lim, Daehee Han, Myoung Im Ahn, Jung Im Jung, Seog Hee Park / Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea.
  • Age/Sex 35 / M
  • Chief Complaint Lt side chest pain for 1 week
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Figure 1

Diagnosis With Brief Discussion

Diagnosis
Bronchogenic cyst in retrocrural space
Radiologic Findings
Chest CT showed well-demarcated, encapsulated cystic lesion in left retrocrural space. The cystic mass showed homogenously low attenuation (28HU). This cystic lesion revealed isointense signal intensity, similar to CSF on T2WI and capsular enhancement on Gd-enhanced scan. On laparoscopic surgical intervention, this cystic mass contained yellowish, pus-like contents (below) and was closely attached to the psoas muscle. On pathologic examination, respiratory epithelium was aligned with the wall of cystic mass, which was consistent with bronchogenic cyst.
Brief Review
Bronchogenic cysts are congenital lesions thought to result from abnormal budding of the embryonic foregut. Mediastinal cysts are far more frequent and do not communicate with the bronchial tree, unlike intraparenchymal cysts in which such communications usually develop, leading to frequent recurrent infection.
At computed tomography (CT), bronchogenic cysts typically manifest as spherical masses of either water or soft-tissue attenuation. However, in one-half of all bronchogenic cysts, the CT density can vary from a low soft-tissue range to higher-than-muscle density, likely due to intracystic hemorrhage, protein, or calcium.
In one report, 68 histopathologically proven cases of bronchogenic cyst were analyzed. There were 58 mediastinal and 10 extramediastinal cysts (85% vs. 15%). Most common location of bronchogenic cyst is carinal area (52%), followed by paratracheal area (19%), esophageal wall (14%) and retrocardiacl area (9%). Especially, the extramediastinal cysts were located in the lung parenchyma (7/10), the diaphragm (2/10) and the pleura in one case. Rarely several cases in retroperitoneal bronchogenic cyst were reported.
On MR scan, bronchogenic cysts shows variable signal instensity which are slightly hyperintense or isointense to skeletal muscle on T1WI and isointense or hyperintense to CSF. These thin-walled cysts are lined with respiratory epithelium and cyst fluid is composed primarily of water admixed with varying amounts of thick proteinaceous mucus. Calcium oxalate crystals have also been detected in the fluid.
Mediastinal cysts are far more frequent and do not communicate with the bronchial tree, unlike intraparenchymal cysts in which such communications usually develop, leading to frequent recurrent infection.
References
1. McAdams HP, Kirejczyk WM, Rosado-de-Christenson ML, Matsumoto S. Bronchogenic cyst: imaging features with clinical and histopathologic correlation. Radiology 2000; 217(2):441-6.
2. Nakata H, Nakayama C, Kimoto T, et al. Computed tomography of mediastinal bronchogenic cysts. J Comput Assist Tomogr 1982; 6:733-738
3. Glazer JS, Siegel MJ, Sagel SS. Low-attenuation mediastinal masses on CT. AJR 1989;152:1173-1177
Keywords
mediastinum, retrocrural space, congenital,

No. of Applicants : 107

▶ Correct Answer : 35/107,  32.7%
  • - Assam Medical college , India samudra borah
  • - Yonsei University College of Medicine, Shinchon Severance hospital , Korea (South) Young Joo Suh
  • - Okayama University , Japan Akihiro Tada
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Hangang sacred heart hospital , Korea (South) You Mie Han
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - KMC,Manipal , India satish maddukuri
  • - CHA Bundang hospital , Korea (South) Hyerin Kim
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Suncheon plus radiology , Korea (South) Park Sang Hyun
  • - kobe city general hospital , Japan rintaro hashimoto
  • - Auckland hospital , New Zealand (Aotearoa) Yuranga Weerakkody
  • - Saint Malo , France jean-baptiste Noel
  • - NTUH , Taiwan Kuei-pin Chung
  • - Korea univ. hospital, radiology department , Korea (South) Choo jiyung
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Vikram hospital , India Pravin Mahadevappa
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - SMC , Korea (South) Yi Kyung Kim
  • - Samsung medical center , Korea (South) Hyun Su Kim
  • - Apollo Hospital, , India Sandip Shah
  • - , Korea (South) Yoo Na Kim
  • - James Paget Hospital , U.K , United Kingdom nabil mahmood
  • - Teleradiology , India Savith Kumar
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - radiologist, aditya imaging centre , India vivek patel
  • - Inha University Hospital , Korea (South) Ju Won Lee
  • - Radiologie Brabois adultes , France ROPION helene
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - NASA SCANS , India RAKESH BHATIA
  • - IRSA , France jean-luc BIGOT
  • - EWHA WOMANS MOKDONG UNIVERSITY HOSPITAL , Korea (South) Sang Min Lee
  • - Seoul St Mary Hospital , Korea (South) Chae Lim
  • - Chonnam National University Hospital , Korea (South) Jung hyun Kim
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
▶ Correct Answer as Differential Diagnosis : 17/107,  15.9%
  • - Severance hospital , Korea (South) Saerom Hong
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Goa Medical College , India Paresh Desai
  • - Youngdong Hospital , Korea (South) Sang Min Lee
  • - Yonsei university Shinchon Severance hospital , Korea (South) Na-young Shin
  • - Onomichi municipal hospital , Japan Ryotaro Kishi
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Istanbul , Turkey Armagan Sarac
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Chonnam National University Hospital , Korea (South) Daun Lee
  • - CHU NANCY , France, Metropolitan GREGORY LESANNE
  • - Radnet Teleradiology , Turkey Murat Ulusoy
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - CLCC Rennes , Canada nicolas gautier
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
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