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Weekly Chest CasesArchive of Old Cases

Case No : 448 Date 2006-05-29

  • Courtesy of Jin Woo Kim, MD, Yo Won Choi, MD. / Hanyang University Hospital, Seoul, Korea
  • Age/Sex 63 / F
  • Chief ComplaintCough and sputum for one week
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Pulmonary Parenchymal Bronchogenic Cyst
Radiologic Findings
The chest radiography shows a cystic lesion with an air-fluid level in the right upper lung zone. CT shows 밺ouble wall?sign (air visible on either side of the wall of the bulla), which suggests bullous disease rather than localized pneumothorax. Our clinical diagnosis was infected bulla.

Wedge resection of cystic mass was performed. Histologic examination showed cyst walls lined by respiratory epithelium, a finding consistent with bronchogenic cyst rather than bulla.
Brief Review
Bronchogenic cyst develops as a result of abnormal budding of the ventral foregut during the gestational period. The wall is lined by ciliated columnar or cuboidal epithelium and is surrounded by tissues that may be found in the normal bronchus, such as cartilage, smooth muscle, elastic tissue and mucous glands.

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.

Differential diagnosis includes abscess or infected bulla, especially when air-fluid level is present. Surgery is recommended for patients with history of repeated infection.
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
Keywords
Lung, Congenital,

No. of Applicants : 45

▶ Correct Answer : 2/45,  4.4%
  • - National Taiwan University Hospital, Taiwan Yu-Feng Wei
  • - Macky Memorial Hospital, Taipei, Taiwan Chia-Fu Tsai
▶ Correct Answer as Differential Diagnosis : 15/45,  33.3%
  • - Inje University Ilsan Paik Hospital, Korea Bae Geun Oh
  • - Ondokuz Mayis University, Samsun, Turkey Cetin Celenk
  • - Dong-Eui Medical Center, Busan, Korea Hoon Sik Jung
  • - Hospital Sotiria, Athens, Greece Tzilas Vasilios
  • - Kashan Universityof Medical Sciences, Kashan, Iran Ebrahim Razi
  • - Radiologie Guiton, La Rochelle, France Jean-luc Bigot
  • - Hangang Sacred Heart Hospital, Korea Eil Seong Lee
  • - Annemasse, Polyclinique de Savoie, France Gay-Depassier Philippe
  • - Kang-dong Sacred Heart Hospital, Korea Kyoung Ja Lim
  • - Diskapi Yildirim Beyazit Hospital, Ankara, Turkey Meric Tuzun
  • - Yonsei University, Shinchon Severance Hospital, Korea Hye-Jeong Lee
  • - Yonsei University, Shinchon Severance Hospital, Korea Yong Eun Chung
  • - Max Hospital, New Delhi, India Vickrant Malhotra
  • - Mubarak Al Kabeer Hospital, Kuwait Varghese Sajeev P. J.
  • - China Medical University Hospital,Taiwan Jun-Jun Yeh
▶ Semi-Correct Answer : 22/45,  48.9%
  • - LIifescan 3T MRI and MDCT scan center, Mumbai, India Jeshil Shah
  • - Yonsei University Shinchon Severance Hospital, Korea Eun Hye Yoo
  • - Pgimer, Chandigarh, India Ram Prakash Galwa
  • - Nottingham City Hospital, United Kingdom Rihit Kochhar
  • - Pusan National University Hospital, Korea Kun-Il Kim
  • - Pgimer, Chandigarh, India Ashish Gupta
  • - Samsung Medical Center, Seoul, Korea Ha Young Kim
  • - Ev. Krkhs. Hubertus, Berlin, Germany Michael Weber
  • - Nirman Hitech Diagnostic Center, Mumbai, India Minal Seth
  • - Sam Anyang Hospital, Korea Jae Seung Seo
  • - Annecy Hospital, France Gilles Genin
  • - Kang-nam St.Mary Hospital, Korea LimChaeHun
  • - Maimonides Medical Center; Brooklyn, New York, USA Naomi Twersky
  • - Homs National Hospital, Homs, Syria Rami Abou Zalaf
  • - Inje University Ilsan Paik Hospital, Korea Seung Tae Lee
  • - Radiologie Guiton, La Rochelle, France Denis Chabassiere
  • - MGM, Medical College, Indore, India Sonali Jain
  • - Incheon Sarang Hospital, Korea Jung Hee Kim
  • - Doctors Hospital, Nassau, Bahamas N.B.S.Mani
  • - Zulekha Hospital, Dubai Saurabh Khandelwal
  • - Ultra Care, Coimbatore, India Debabrata Das
  • - India Sanjeevi Chandrasekaran
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