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Weekly Chest CasesArchive of Old Cases

Case No : 1165 Date 2020-02-25

  • Courtesy of Jong Eun Lee, Won Gi Jeong, Yun-Hyeon Kim / Chonnam National University Hospital
  • Age/Sex 58 / M
  • Chief ComplaintLeft flank pain
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Intradiaphragmatic bronchogenic cyst
Radiologic Findings

Pre- and post-contrast mediastinal window setting axial chest CT images shows a well-demarcated lesion with subtle high attenuation and poor contrast enhancement along the left diaphragm. In coronal reconstructed image, the lesions shows splitting the left crus of the diaphragm and and abutting the stomach.

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.
CT findings of bronchogenic cyst have been well described in the literature. They are usually sharply margined with soft tissue or water attenuation, with cystic characteristics. Some bronchogenic cysts may have soft tissue attenuation, and contrast enhanced CT may help in distinguishing malignancy by the lack of enhancement.
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.
They occur most commonly within the mediastinum but rarely in the diaphragm. Up to now, there have been few reported cases of intradiaphragmatic bronchogenic cyst reported.
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.
Please refer to
Case 706,
KSTR Imaging conference 2010 Summer  Case 18,
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. Yoon JH, Lee KN, Kang EJ, Kim MS, Choi PJ, Roh, MS. Bronchogenic Cyst in an Intradiaphragmatic Location: A Case Report. J Korean Soc Radiol. 2018;79(4):227-32.
Keywords
diaphragm, bronchogenic Cyst ,

No. of Applicants : 82

▶ Correct Answer : 20/82,  24.4%
  • - CH de la Cote Basque , France PAUL ARDILOUZE
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Other , Korea (South) HONG SANG HYUP
  • - Other , Korea (South) HYEON IL CHOI
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Chonnam National University Hospital , Korea (South) SUNGMO KIM
  • - , Korea (South) JI HOON NOH
  • - Hallym University Dongtan Medical Center , Korea (South) MINSU KIM
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Chonnam National University Hwasun Hospital , Korea (South) JEONG YEOP LEE
  • - Kyeongpook National University Hospital , Korea (South) PARK BYUNG GEON
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
  • - , India SHYJUMON GEORGE
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Chonnam National University Hospital , Korea (South) SEUNG WAN KANG
  • - Private sector , Greece VASILIOS TZILAS
  • - Chonnam National University Hwasun Hospital , Korea (South) WONGI JEONG
  • - Chonnam National University Hospital , Korea (South) JONG EUN LEE
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
▶ Correct Answer as Differential Diagnosis : 15/82,  18.3%
  • - The University of Kyoto Hospital , Japan TOMOAKI OTANI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Other , Korea (South) SEONGSU KANG
  • - , Jordan HISHAM IBRAHIM KHATIB
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Medicheck health care , Korea (South) Chae hun Lim
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - TB centre kasaragod. , India rikhy krishnan
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Nishida Hospital , Japan SHOJI OKUDA
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - , Japan KAZUMA TERAUCHI
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