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Weekly Chest CasesArchive of Old Cases

Case No : 780 Date 2012-10-08

  • Courtesy of Miyeon Yie, MD. Tae Sung Kim, MD. / Samsung Medical Center
  • Age/Sex 38 / M
  • Chief ComplaintCough
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Figure 1.

Diagnosis With Brief Discussion

Diagnosis
Intrapulmonary bronchogenic cyst
Radiologic Findings
Chest CT shows a well-demarcated cystic lesion with an internal air-fluid level located within the left lower lobe. There was no visible communication between the bronchus and the lesion on imaging studies.
On the left lower lobectomy specimen, a unilocular cyst with an internal yellowish mucoid material was revealed. The final pathological diagnosis was an intrapulmonary bronchogenic cyst with surrounding fibrosis and bronchiolization.
Brief Review
Bronchogenic cyst is a congenital lesion arising from abnormal budding of the embryonic foregut, which occurs between the 26th and 40th days of gestation. The cysts are lined by respiratory epithelium with a wall containing glands, cartilage, and smooth-muscle elements. Most of the cysts are located in the mediastinum along the tracheobronchial tree, but they can also be found in the lung parenchyma or may extend to or below the diaphragm as dumb-bell cysts.
On computed tomography (CT), intrapulmonary bronchogenic cysts appear as a sharply defined, solitary, uncalcified, round or oval density presenting as one of three categories: a cyst with a homogeneous water density, an air-filled cyst, or a cyst containing an air-fluid level. The high attenuation of bronchogenic cysts on unenhanced CT scans is caused by hemorrhage, proteinaceous mucus, calcium, or calcium oxalate. Unlike mediastinal cysts, communication with bronchial tree or adjacent lung parenchyma is far more frequent in intrapulmonary bronchogenic cysts, leading to frequent recurrent infection. There is generally no controversy surrounding surgical treatment of bronchogenic cysts with repeated infections.
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. Lee DH, Park CK, Kum DY et al. Clinical characteristics and management of intrathoracic bronchogenic cysts: a single center experience .Korean J Thorac Cardiovasc Surg. 2011;44:279
Keywords
lung, congenital,

No. of Applicants : 81

▶ Correct Answer : 16/81,  19.8%
  • - Scans world , India Philson Mukkada
  • - Kurashiki Seijin-byo Center , Japan Akihiro Tada
  • - McGill University , Canada Micheal McInnis
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Myongji hospital , Korea (South) Ji Ye Lee
  • - Asan Medical Center , Korea (South) Hye Jeon Hwang
  • - Asan medical center , Korea (South) Hyun Joo Lee
  • - China Medical University , Chia-Yi Christian Hospital ,Taiwan, R.O.C. , Taiwan Jun Jun Yeh
  • - Asan Medical Center , Korea (South) Eunyoung Kim
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Saint Malo , France jean-baptiste Noel
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - All India Institute of medical sciences , India Justin Moses
  • - NASA SCANS , India RAKESH BHATIA
▶ Correct Answer as Differential Diagnosis : 21/81,  25.9%
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - McGill University Health Center , Canada Alexandre Semionov
  • - University of British Columbia , Canada Amr Ajlan
  • - Bupyong Serim Hospital , Korea (South) Hee Seok Choi
  • - Chonnam National University Hospital , Korea (South) So yeon Ki
  • - Korea university , Korea (South) Kun Woo Kang
  • - Chonnam national univ. hospital , Korea (South) Choi Seul-Gi
  • - NIMS, HYDERABAD , India bhaskar kakarla
  • - GHICL , France manuel toledano
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Asan Medical Center , Korea (South) Sang Min Lee
  • - Asan Medical Center , Korea (South) Ji Eun Kim
  • - radiologist, aditya imaging centre , India vivek patel
  • - University of Pennsylvania , United States Lisa Jones
  • - Hanyang University Hospital , Korea (South) Yo Won Choi
  • - XiangYa hospital , China Xia Yu
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - MITOYO GENERAL HOSPITAL , Japan Mototsugu Saeki
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Babaeski Devlet Hastanesi , Turkey Umut Ugur
  • - Chonnam National University Hospital , Korea (South) Jung hyun Kim
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