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Bronchogenic cyst with tracheal involvement
1Department of Otolaryngology-Head & Neck Surgery, University of Illinois College of Medicine, Chicago.
Insights
Bronchogenic cysts in infants can cause airway obstruction. Endoscopic aspiration of these cysts, while potentially relieving symptoms, carries risks like severe bradycardia due to vagal nerve proximity.
Area of Science:
- Pediatric Surgery
- Developmental Biology
- Respiratory Medicine
Background:
- Bronchogenic cysts are rare congenital anomalies originating from the primitive foregut.
- These cysts can lead to significant ventilatory compromise in infants and children.
- Symptoms include stridor and obstructive apnea due to airway compression.
Observation:
- A 2-month-old infant presented with stridor and apnea caused by a tracheal bronchogenic cyst.
- Endoscopic cyst aspiration during bronchoscopy led to severe bradycardia (140 to 50 bpm).
- Blood pressure remained stable with 100% oxygen saturation during the event.
Findings:
- The bronchogenic cyst was closely associated with the vagus nerve.
- Vagal stimulation during aspiration is the suspected cause of the bradycardia.
- Surgical intervention (thoracotomy) was ultimately required.
Implications:
- Bronchogenic cysts should be considered in the differential diagnosis of neonatal airway obstruction.
- Endoscopic aspiration of such cysts is not without risk and may not replace surgical treatment.
- Awareness of potential vagal nerve involvement is crucial during procedures on these lesions.
Abstract:
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.