Central bronchogenic cyst: treatment by extrapleural percutaneous aspiration.

FIG 2 (below)-Computed tomogram showing 6 French dilator of Cope catheter introduction set lying extrapleurally, adjacent to cyst wall Bronchogenic cysts usually present as a chance finding onset of central and right sided chest pain, severe in routine chest radiographs. Less commonly an enough to require regular oral analgesics, and a nonincrease in the size of or bleeding into the cyst may productive cough. She had no history of cardiorescause acute chest pain or respiratory embarrassment. piratory disease and had never smoked. Physical We aspirated a large bronchogenic cyst undercomputed examination yielded normal results. tomographic guidance by using a new extrapleural, Posteroanterior and lateral plain chest radiographs percutaneous approach. This procedure was well -showed a large homogeneous opacity lying posterotolerated and allowed complete drainage of the cyst. inferior to the carina, displacing the heart anteriorly and splaying the carina (fig 1). A computed tomogram showed the opacity to be a unilocular cyst with a well Case history defined wall, fulfilling the radiological criteria for a A 24 year old medical physicist presented with a two bronchogenic cyst.' There was also a very small right week history of chest pain. She described the gradual pleural effusion. Her peak expiratory flowwas reduced, being 355 1/min or 78% of the predicted value, and maximum flow volume loops showed an abnormality of the expiratory limb, indicative of mild intrathoracic obstruction. Later, a copy was obtained of a routine l g ms3: tchest radiograph taken one year before; careful inspection of this showed the cyst to be present but much smaller. Aspiration of the central bronchogenic cyst was performed by extrapleural percutaneous aspiration. The patient lay on her front and a 21 gauge Chiba needle was advanced under computed tomographic guidance to just outside the parietal pleura. The needle was than advanced in a series of small steps, each preceded by injections of 2-5 ml saline to separate the pleura from the chest wall. In this way the needle was guided down the space created until the cyst was reached. After introduction of a guide wire a number 6 French catheter was advanced into the cyst (fig 2), and 160 mls of dark brown viscous fluid was drained. A computed tomogram immediately after aspiration (fig 3) showed almost complete disappearance of the cyst. ... i 'S | ............... 4 w . ~~~~~~~~~~~~~~~.. .. 'i............ ...... .