대한흉부영상의학회 Weekly Chest Cases

Case No : 494 Date 2007-04-16

Courtesy of Young A Bae, M.D., Kyung Soo Lee, M.D. / Samsung Medical Center, Sungkyunkwan University, Korea
Age/Sex 67 / M
Chief ComplaintAbnormality on chest radiograph

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Diagnosis With Brief Discussion

Diagnosis: Bronchogenic Cyst
Radiologic Findings: Chest radiograph shows soft tissue bulging contour at right hemidiaphragm. Chest CT scans show well-defined, low density homogeneous mass abutting right hemidiaphragm. This mass is not enhanced after administration of contrast media. Thoracic MRI was performed which revealed slightly high signal intensity to that of muscle on T1-weighted image and bright signal intensity on T2-weighted image.
Brief Review: Bronchogenic cysts result from abnormal ventral budding or branching of the tracheobronchial tree during embryologic development. They may be filled with clear, serous fluid or thick, mucoid material. They may occur in any part of the mediastinum, but most are near the tracheal carina in the middle or posterior mediastinum. Less often, they may occur within the lung parenchymas, pleura, or diaphragm.
On CT scans, a bronchogenic cyst appears as a single, smooth, round or elliptic mass with an imperceptible wall and uniform attenuation. The attenuation value is dependent on the contents of the cyst and can vary from water attenuation to soft tissue attenuation. At T2-weighted MR imaging, cysts have high signal intensity regardless of the nature of the cyst contents, but variable patterns of signal intensity are seen at T1-weighted MR imaging because of variable cyst contents and the presence of protein, hemorrhage, or mucoid material.
References: 1. Jeung MY, Gasser B, Gangi A, Bogorin A, Charneau D, Wihlm JM, Dietemann JL, Roy C. Imaging of cystic masses of the mediastinum. Radiographics. 2002 Oct;22 Spec No:S79-93. Review.
2. McAdams HP, Kirejczyk WM, Christenson MLRd, Matsumoto S. Bronchogenic cyst: Imaging features with clinical and histopathologic correlation. Radiology 2000; 217:441-446
Keywords: Lung, Congenital,

No. of Applicants : 49

▶ Correct Answer : 7/49, 14.3%

- Ewha Womans University MokDong Hospital, Korea Yoo Kyung Kim
- Akdeniz University School of Medicine, Radiology Dept Antalya, Turkey Gokhan Arslan
- Yongsan Hospital, College of Medicine, Chung-Ang University, Korea Jae Seung Seo
- Department of radiology, Severance hospital, Korea Myoung Soo Lee
- IRSA, La Rochelle, France Denis Chabassiere
- Annecy Hospital, France Gilles Genin
- Hospital of China Medical University, Taiwan Sea Harn, Pan

▶ Correct Answer as Differential Diagnosis : 7/49, 14.3%

- CHU Grenoble, France Bing Fabrice
- Ruby Hall Clinic, Pune, India Nikhil Unune
- IRSA La Rochelle, France Jean-Luc BIGOT
- Nanavati Hospital, Mumbai, India Ajay Kumar
- Hospital Sotiria, Athens, Greece Vasilios Tzilas
- Aims, New Delhi, India Ashish Gupta
- China Medical University Hospital, Taiwan Jun-Jun Yeh

▶ Semi-Correct Answer : 2/49, 4.1%

- Osaka University, Japan Osamu Honda
- ASCS, Safwa, Saudi Arabia Kalari Adinarayana

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 494 Date 2007-04-16

Discussion

No. of Applicants : 49