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Recurrent respiratory obstruction from a mediastinal bronchogenic cyst
S R Johnston1, A Adam, D J Allison
1Division of Respiratory Medicine, Hammersmith Hospital, London.
Thorax
|August 1, 1992
Summary
A large bronchogenic cyst caused atrial fibrillation and airflow obstruction, mimicking lymphoma. Percutaneous aspiration and instillation of bleomycin and alcohol successfully managed the cyst and improved lung function.
Area of Science:
- Cardiology
- Pulmonology
- Thoracic Surgery
Background:
- Bronchogenic cysts are congenital lung malformations that can present with various symptoms.
- Mediastinal masses can cause significant cardiopulmonary compromise.
- Misdiagnosis of mediastinal masses can lead to delayed or inappropriate treatment.
Observation:
- A large mediastinal bronchogenic cyst presented with acute paroxysmal atrial fibrillation and severe airflow obstruction.
- The patient had a 24-year history of similar, previously misdiagnosed symptoms attributed to mediastinal lymphoma.
- Surgical intervention for recurrent cyst swelling was not feasible.
Findings:
- Percutaneous extrapleural aspiration provided initial decompression and substantial improvement in lung function.
- Recurrent cyst enlargement occurred despite initial aspiration.
- Percutaneous instillation of bleomycin and alcohol after repeat aspiration was employed to prevent cyst recurrence.
Implications:
- Percutaneous aspiration is an effective initial treatment for symptomatic bronchogenic cysts causing cardiopulmonary compromise.
- Sclerotherapy with bleomycin and alcohol may be a viable option for managing recurrent or surgically inaccessible bronchogenic cysts.
- This case highlights the importance of considering rare diagnoses like bronchogenic cysts in patients with recurrent, unexplained cardiopulmonary symptoms.