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.

[1]  G. Guyatt,et al.  The Developing Human: Clinically Oriented Embryology, 6th edition, Keith L. Moore, T.V.N. Persaud (Eds.). W.B. Saunders, Philadelphia (1998) , 1999 .

[2]  C. Marks,et al.  The embryologic basis of tracheobroncho-pulmonary maldevelopment. , 1987, International surgery.

[3]  B. Wenig,et al.  Tracheal Bronchogenic Cyst: A New Clinical Entity? , 1987, The Annals of otology, rhinology, and laryngology.

[4]  S. Luck,et al.  Diagnostic dilemmas of mediastinal cysts. , 1985, Journal of pediatric surgery.

[5]  S. R. Cohen,et al.  Foregut Cysts Presenting as Neck Masses , 1985, The Annals of otology, rhinology, and laryngology.

[6]  G. Holt,et al.  Bronchogenic Cyst Presenting as Deep Neck Abscess , 1984, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[7]  Jerome W. Thompson,et al.  Foregut Cysts in Infants and Children , 1982, The Annals of otology, rhinology, and laryngology.

[8]  L. Holinger,et al.  Etiology of Stridor in the Neonate, Infant and Child , 1980, The Annals of otology, rhinology, and laryngology.

[9]  J. Haller,et al.  Surgical management of lung bud anomalies: lobar emphysema, bronchogenic cyst, cystic adenomatoid malformation, and intralobar pulmonary sequestration. , 1979, The Annals of thoracic surgery.

[10]  R. Bower,et al.  Mediastinal masses in infants and children. , 1977, Archives of surgery.

[11]  J. Thompson,et al.  Presternal bronchogenic cysts. , 1977, Archives of otolaryngology.

[12]  N. T. Griscom,et al.  Bronchogenic cysts of the mediastinum in infancy. , 1969, The New England journal of medicine.

[13]  A. Jaretzki,et al.  Congenital bronchopulmonary-foregut malformation. Pulmonary sequestration communicating with the gastrointestinal tract. , 1968, The New England journal of medicine.

[14]  R. Asnes,et al.  Bronchogenic cysts of the mediastinum in infancy: a cause of acute respiratory distress. , 1967, The Annals of thoracic surgery.

[15]  E. Goldsmith,et al.  Bronchogenic cysts of the mediastinum in children. , 1966, Journal of pediatric surgery.

[16]  L. F. Rogers,et al.  BRONCHOGENIC CYST. A REVIEW OF 46 CASES. , 1964, The American journal of roentgenology, radium therapy, and nuclear medicine.

[17]  E. Berman,et al.  Bronchiogenic mediastinal cysts in infants: case report and review of the literature. , 1962, Pediatrics.

[18]  Little Eh.  Congenital cysts and cystic tumors of the mediastinum. , 1953 .

[19]  H. C. Maier.  BRONCHIOGENIC CYSTS OF THE MEDIASTINUM , 1948, Annals of surgery.

[20]  J. Moore.  Congenital cysts of the lung; report of two cases. , 1947, North Carolina medical journal.