대한흉부영상의학회 Weekly Chest Cases

Case No : 597 Date 2009-04-05

Courtesy of Gong-yong Jin / Chonbuk National University Hospital, Medical School
Age/Sex 54 / F
Chief ComplaintIncidental lung mass during healthy screening

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Diagnosis With Brief Discussion

Diagnosis: Intrapulmonary bronchogenic cyst
Radiologic Findings: Chest radiograph showed about 1.5 cm, well-defined solitary pulmonary nodule (SPN) at right hilum (Fig 1). Non-contrast axial CT scan obtained with mediastinal setting showed a homogenous, well-defined nodule with smooth margin in the anterior segment of RUL (Fig 2). Contrast-enhanced axial CT scan obtained with mediastinal setting showed mild enhancement (Fig 3). On PET/CT, SPN showed no hypermetabolism (Fig 4). Pathologic gross findings showed 1.5 cm, well capsulated fibrous cystic mass that contained mucous material.
Brief Review: Bronchogenic cysts are uncommon mass that result from abnormal budding of the ventral foregut between the 26th and 40th days of gestation. Bronchogenic cysts have a fibrous capsule, contain cartilage, and are lined with respiratory epithelium. The usual radiographic finding of an intrapulmonary bronchogenic cyst was a well defined, round or oval density presenting as: 1) a cyst with a water density, 2) an air-filled cyst, or 3) cyst containing an air-fluid level. The CT attenuation values of the intrapulmonary bronchogenic cysts were similar from those of mediastinal bronchogenic cysts. It may be difficult to differentiate a bronchogenic cyst from acquired cystic lesions, such as an abscess and infected bulla, especially when the lesions manifested are air-filled or have an air-fluid level. Because there are no specific CT or MR imaging findings that allow easy differentiation, reviewing the patient's clinical history and previous radiologic studies may be helpful.
References: 1. Limaiem F, Ayadi-Kaddour A, Djilani H, Kilani T, El Mezni F. Pulmonary and mediastinal bronchogenic cysts: a clinicopathologic study of 33 cases
2. Intrapulmonary bronchogenic cysts: computed tomography, clinical and histopathologic correlations
Keywords: Lung, Congenital,

No. of Applicants : 90

▶ Correct Answer as Differential Diagnosis : 2/90, 2.2%

- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- POPOVO HOSPITAL , Bulgaria VLADISLAV RUSINOV

▶ Semi-Correct Answer : 15/90, 16.7%

- MD SKNMC & GH,Pune,Maharashtra, INDIA , India Sushant Bhadane
- Father Muller Medical College , Mangalore , India nabil mahmood
- S V S MEDICAL COLLEGE , India SUNIL ALMALE
- Assam medical college , India Karunakaran M
- Kasturba Medical College Manipal , India Paresh Desai
- Apollo Gleneagles hosp , India salim parvez
- EKH-Berlin , Germany Michael Weber
- Asian Heart Institute, Nirman Hitech & Apollo clinic , India Jeshil Shah
- CHRU lille , France manuel toledano
- Yashoda Superspeciality hospital , India Pravin Mahadevappa
- Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
- NASA SCANS , India RAKESH BHATIA
- Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
- Trakya University School of Medicine , Turkey Umut Ugur
- All India Institute of medical sciences , India Justin Moses

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 597 Date 2009-04-05

Discussion

No. of Applicants : 90