Cases reported • Bronchogenic Cyst; Bronchial Cyst

1/6. Recurrent respiratory obstruction from a mediastinal bronchogenic cyst.

A large mediastinal bronchogenic cyst presented acutely with paroxysmal atrial fibrillation and severe airflow obstruction. The patient had experienced identical symptoms on two other occasions over the previous 24 years. These had been previously misdiagnosed as due to a mediastinal lymphoma. Percutaneous extrapleural aspiration successfully decompressed the cyst with substantial improvement in lung function. Recurrent swelling of the cyst occurred that could not be relieved surgically. After repeat aspiration percutaneous instillation of bleomycin and alcohol has been used to prevent further increase in the size of the cyst.

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2/6. Mediastinal bronchogenic cyst. A cause of upper airway obstruction.

Although bronchogenic cysts may involve the mediastinum, they have rarely been responsible for significant upper airway obstruction. We describe a young man who had a rapidly expanding cervical mass due to the migration of a mediastinal bronchogenic cyst. Flow-volume loops confirmed the presence of a variable intrathoracic obstruction. The patient rapidly developed respiratory failure requiring urgent intubation and surgical resection.

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3/6. Multiple cervical bronchogenic cysts.

Bronchogenic cysts are rare, benign, congenital lesions that occur as a result of aberrant development of the tracheobronchial tree during embryogenesis. They usually present during the first decade of life and are encountered predominantly within the mediastinum or the lung parenchyma. In a few instances, they appear within the neck mimicking a neoplasm and, depending on their size and site, may also cause acute upper respiratory obstruction. We describe a case of two cervical bronchogenic cysts adjacent to the larynx in a child who presented with a hoarse voice.

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4/6. bronchogenic cyst with tracheal involvement.

Bronchogenic cysts are uncommon developmental anomalies of the primitive foregut that can produce symptoms of ventilatory compromise in infants and children. A 2-month-old child presented with episodes of stridor and obstructive apnea due to a bronchogenic cyst compressing the trachea and causing near-total obstruction. Aspiration of the cyst during bronchoscopy resulted in severe bradycardia (from 140 to 50 beats per minute), although blood pressure was stable and oxygen saturation remained at 100%. Subsequent elective thoracotomy revealed the cyst to be intimately associated with the vagus nerve, and vagal stimulation may have caused the bradycardia. Bronchogenic cysts, although rare, should be considered in the differential diagnosis of infants and children undergoing direct laryngoscopy and bronchoscopy for airway compromise. The endoscopic aspiration of cystic tracheal and bronchial lesions may not obviate the need for more definitive surgical treatment and, as this case demonstrates, is not free of potential hazard.

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5/6. bronchogenic cyst: a cause of pulmonary artery obstruction and breathlessness.

A young woman presenting with breathlessness and a normal chest roentgenogram was found to have unilateral absent lung perfusion on an isotope scan. This was due to a bronchogenic cyst obstructing the right pulmonary artery. This is a rare cause of unilateral absence of lung perfusion and an unusual mode of presentation of a bronchogenic cyst.

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6/6. Fourth branchial pouch cyst: an unusual cause of neonatal stridor.

Fourth branchial pouch anomalies are extremely rare and only a few such cases showing sinuses and cystic masses have been reported in the literature. We describe a patient who presented on the third day of life with cystic neck swelling of fourth branchial pouch origin giving rise to respiratory obstruction and stridor. Despite repeated aspiration of the cystic mass to relieve respiratory obstruction, rapid recurrence of the mass continued to cause stridor and ultimately required surgical excision. The clinical, radiological, and histopathological findings of this unusual condition are discussed with a review of the literature.

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