대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Pulmonary Bronchogenic Cyst

Radiologic Findings

CT scans show multiloculated cystic lesion and surrounding small cysts in left lower lobe. Some of large cysts show mild irregular wall thickening and air-fluid level. On operation, there is unilocular lobulated cyst and a few small cysts around the main cyst. Histopathologic examination demonstrated pulmonary bronchogenic cyst with focal acute inflammation and granulation tissue.

Brief Review

Bronchogenic cysts result from defective growth of the lung bud. They are lined by ciliated epithelium and have focal areas of hyaline cartilage, smooth muscle, and bronchial glands within their walls.

Although a majority of bronchogenic cysts is known to arise in the mediastinum, less than a third of bronchogenic cysts have been reported to arise within the lung parenchyma. Intraparenchymal (pulmonary) bronchogenic cyst is usually solitary and appears no different radiologically from bronchogenic cysts arising in the mediastinum ?a sharply defined, uncalcified round or oval density showing homogeneous internal water density. The attenuation of the internal content may be higher owing to higher concentrations of proteinaceous mucus, hemorrhage, calcium, or calcium oxalate. Intraparenchymal bronchogenic cyst may be air-filled or even demonstrate an air-fluid level depending on the presence of communication with an adjacent bronchus. This may explain the relatively higher incidence of infection than in its mediastinal counterpart.

Yoon et al. report that most intraparenchymal bronchogenic cysts arise in the lower lobes and have areas of mosaic low-attenuation surrounding the cyst corresponding to areas of emphysema. They think that long-standing multiple episodes of subclinical inflammation may have led to bronchiolization and fibrotic change in the surrounding alveoli in their patients.

References

1. Yoon YC, Lee KS, Kim TS et al. Intrapulmonary bronchogenic cyst: CT and pathologic findings in five adult patients AJR 2002;179:167-170

2. McAdams HP, Kirejczyk WM, Rosado-de-Christenson ML et al. Bronchogenic cyst: imaging features with clinical and histopathologic correlation Radiology 2000;217:441-446

3. Matzinger MA, Matzinger FR, Sachs HJ. Intrapulmonary bronchogenic cyst: spontaneous penumothorax as the presenting symptom AJR 1992;159:987-988

4. 2. Georges R, Deslauriers J, Duranceau A, Vaillancourt R, Deschamps C, Beauchamp G, Page A, Brisson J. Clinical spectrum of bronchogenic cysts of the mediastinum and lung in the adult. Ann Thorac Surg 1991;52 6-13

Keywords

Lung, Congenital,