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Bronchogenic cysts
M Di Lorenzo1, P P Collin, R Vaillancourt
1Department of Surgery, University of Montreal, Quebec, Canada.
Insights
This study found most bronchogenic cysts occur in the mediastinum, not the lung. Surgical excision leads to complete cure in pediatric patients.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Medical Imaging
Background:
- Bronchogenic cysts are congenital anomalies that can cause respiratory distress in infants.
- Their intraparenchymal location is often emphasized, but mediastinal cysts are also common.
Purpose of the Study:
- To analyze the location, diagnosis, and treatment of bronchogenic cysts in pediatric patients.
- To compare findings with existing literature on cyst location.
Main Methods:
- Retrospective review of 26 pediatric patients treated for bronchogenic cysts between 1967 and 1987.
- Utilized chest films, tomography, computed tomography (CT) scans, barium esophagograms, and bronchoscopy.
- Surgical excision or resection (segmentectomy/lobectomy) based on cyst location.
Main Results:
- Majority of cysts (65%) were mediastinal, contrary to intraparenchymal predominance in literature.
- Only 27% were intraparenchymal; 8% in the inferior pulmonary ligament.
- Preoperative diagnosis accuracy was 73%.
- Surgical excision was effective, with low complication rates (pneumonia, transient phrenic nerve paresis).
Conclusions:
- Mediastinal bronchogenic cysts are more common than intraparenchymal ones in this pediatric cohort.
- Surgical management is highly effective, leading to complete cure with minimal sequelae.
Abstract:
Between 1967 and 1987, 26 patients with bronchogenic cysts were treated in our institution: 15 females and 11 males, ranging in age from 2 months to 14 years (average 6 years, 4 months). Only four patients (15%) were 1 year old or less. Seven patients presented with asymptomatic lesions discovered on chest film. Nineteen patients presented with respiratory symptoms. Of note are the four patients aged 1 year or less, who presented with dyspnea and cyanotic spells. Only one of them presented with dysphagia. All patients underwent routine chest films and tomography and, later, computed tomography (CT) scan of the thorax once the study became available. Barium esophagogram and bronchoscopy were performed as required. Contrary to what has been published concerning the intraparenchymal location of bronchogenic cysts, the majority of the cysts (65%) were located in the mediastinum, usually in close proximity to the carina, mainstem bronchi, trachea, esophagus, or pericardium. Only 27% (7 of 26) were intraparenchymal, and 8% (2 of 26) were situated in the inferior pulmonary ligament. A correct preoperative diagnosis was made in 19 patients (73%). Intrapulmonary lesions were removed by segmentectomy or lobectomy. Cysts located elsewhere were simply excised. Among the cysts adhering to the trachea, 50% (two of four) required suture of the membranous trachea after excision. Postoperative complications included one pneumonia, which responded to antibiotics, and one transient paresis of the right phrenic nerve. Follow-up averaged 17 months (range, 0 to 17 years). No sequelae were noted and all patients were cured.