Chest
Volume 106, Issue 1, July 1994, Pages 79-85
Journal home page for Chest

Clinical Investigations
Thoracic Surgery
Presentation and Management of Bronchogenic Cysts in the Adult

https://doi.org/10.1378/chest.106.1.79Get rights and content

Bronchogenic cysts are congenital anomalies of the bronchial tree that are often asymptomatic at presentation in adults. Management of asymptomatic bronchogenic cyst in this population remains controversial. Eighteen patients with bronchogenic cysts were treated at our institution since 1975. At initial presentation, 10 patients (56 percent) were asymptomatic and 8 (44 percent) were symptomatic. Cough and pain were the most frequent symptoms. Two patients presented with potentially serious complications, one with respiratory distress from airway compression and the other with infection and airway fistulae. Chest radiographs were abnormal but nondiagnostic in 17 out of 18 (94 percent) patients. Chest computerized tomography (CT) scans were abnormal in eight of eight (100 percent) patients, but they confirmed the benign cystic nature in only five of eight (62.5 percent). Overall, considering the use of all imaging modalities and clinical suspicion, bronchogenic cyst was considered in the preoperative differential diagnosis in only 11 of 18 (61 percent) patients. Fifteen of 18 cysts were resected initially. Three of the asymptomatic patients who were followed up initially ultimately required resection because of the development of symptoms. A trend toward increased postoperative complications was noted in patients who were symptomatic at the time of surgery (27 percent vs 14 percent). In conclusion, adult patients with asymptomatic bronchogenic cyst may develop symptoms over time. Symptoms in adults can sometimes be potentially serious. Since a confident preoperative diagnosis is not always possible and because surgical complications may be more common in the symptomatic patient, we recommend surgical resection of all suspected bronchogenic cysts in operable candidates.

Section snippets

Patients and Methods

The medical records of all patients who underwent surgical excision of pathologically confirmed bronchogenic cysts at our institution during the period from 1975 to 1992 were reviewed. Data were collected with regard to demographics, mode of presentation, reliability of common imaging techniques (chest radiograph, tomogram, and CT), management, surgical findings, and incidence of operative and postoperative complications stratified by symptom status at the time of surgery, To determine the

Results

During a 17-year period between 1975 and 1992, 18 adult patients underwent surgical excision of thoracic bronchogenic cysts. There were 12 men and 6 women and their ages ranged from 17 to 70 years (mean 37.6 years). The follow-up period after surgical excision ranged from 12 months to 11 years with one patient being lost to follow-up because of residence abroad.

Discussion

Bronchogenic cysts are one of the most common bronchopulmonary malformations.30 Though more commonly mediastinal in location,2 cysts arising at a later stage of development may be intraparenchyma12 and in rare cases have occurred in presternal tissues,31 diaphragm,32 spine,2 skin and subcutaneous tissue,33 pericardium,34 neck,35 abdomen,36 or have extended from the mediastinum through the diaphragm into the abdomen—“dumbbell” cysts.37 The cyst wall is lined by ciliated pseudostratified columnar

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