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| CASE REPORT |
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| Year : 2017 | Volume
: 10
| Issue : 4 | Page : 394-395 |
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Intrapulmonary bronchogenic cyst
Suresh Vasant Phatak, Neeraj Arun Patange
Department of Radiodiagnosis, JNMC, Wardha, Maharashtra, India
| Date of Submission | 29-Aug-2016 |
| Date of Acceptance | 20-Dec-2016 |
| Date of Web Publication | 4-Sep-2017 |
Correspondence Address:
Neeraj Arun Patange
JNMC, Wardha, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0975-2870.213927
Bronchogenic cysts are congenital anomaly caused by abnormal bronchial development from the primitive ventral foregut, which arises from cells isolated from the main pulmonary branching when lung bud separates from the primitive gut. We are reporting a case of 14-year-old boy who presented with nonspecific chest pain and cough. Keywords: Bronchogenic cyst, computed tomography, congenital cyst, lung cyst
How to cite this article:
Phatak SV, Patange NA. Intrapulmonary bronchogenic cyst. Med J DY Patil Univ 2017;10:394-5 |
| Introduction | |  |
Bronchogenic cysts represent congenital anomaly caused by abnormal bronchial development from primitive ventral foregut arising from cells isolated from main pulmonary branching when lung bud separates from primitive gut.[1] Bronchogenic cysts can have a wide range of clinical and radiological manifestations. In infancy and early childhood, airway compression of soft tracheobronchial tree often causes symptoms and occasionally leads to life-threatening complications. In adults, disease is asymptomatic and is only incidentally recognized in radiological investigation.
| Case Report | | |
A 14-year-old boy presented with nonspecific chest pain and cough of 6 months duration. Chest radiograph revealed a lobulated lung mass in the left lung [Figure 1]. Computed tomography (CT) thorax showed water density thin walled sharply defined solitary mass in left upper lobe with no calcifications, air-fluid levels, and few satellite shadows surrounding the lesion without adjacent mosaic attenuation pattern (Hounsfield units [HU] value 12). Other laboratory investigations were unremarkable [Figure 2] and [Figure 3]. | Figure 1: Scout film shows a lobulated well defined lesion in left mid zone surrounded by normal lung parenchyma
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 | Figure 2: NECT thorax (lung window) image showing water density thin walled sharply defined solitary cystic mass in the left upper lobe with no calcifications, air-fluid levels and few satellite shadows surrounding the lesion without adjacent mosaic attenuation pattern (Hounsefield units value 12)
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 | Figure 3: NECT of thorax( mediastinal window) shows a cystic water density lesion with well-defined walls in the left lung
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| Discussion | | |
The earliest signs of lung development occur around 4 weeks after conception with the appearance of a bud (the tracheal diverticulum) from the primitive foregut. Lung development can be described in four stages embryonic, glandular, canalicular, and saccular. Embryonic stage is between 4 and 6 weeks. Postconception during which the tracheal diverticulum elongates and bifurcates to form left and right lung buds.[2] Bronchogenic cysts are formed during embryonic stage [Figure 4]. | Figure 4: Embryonic stage of Lung development showing formation of Lung Bud
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Intrapulmonary bronchogenic cysts are seen as sharply defined, solitary, densities presenting as cysts with a homogeneous water density. They have a predilection for the lower lobes.[3] The CT density of bronchogenic and esophageal cysts may vary from water density (0–20 HU) to high-density (80–90 HU). The causes of high attenuations are hemorrhage, proteinaceous mucus, or calcium oxalate. Areas of low attenuation in the surrounding parenchyma and band like linear attenuation corresponds on histopathology to areas of emphysema and fibrosis.[4] The magnetic resonance imaging appearance depends on the presence of proteinaceous material in cyst. Serous cyst fluid shows low signal intensities on T1-weighted images and high signal intensities on T2-weighted images. Most bronchogenic cysts contain proteinaceous material and have high signal intensity on T1-weighted images.[5]
Differential diagnosis of an intrapulmonary bronchogenic cyst includes a pulmonary lymphangioma, though these are uncommon. If the cyst contains air, abscess, or infected bulla should be included in the differential. If they are abutting the mediastinum, other mediastinal congenital cysts, pericardial cysts, or cysts from spinal origin could be considered. Furthermore, when the cyst fluid is hyperdense, distinction between an intraparenchymal bronchogenic cyst and a solid lung nodule may be quite difficult. Bronchogenic cysts typically do not enhance, which helps to distinguish them from other solid nodules on contrast-enhanced cross-sectional imaging.[6]
The appearance of intrapulmonary bronchogenic cyst on chest radiographs and CT scan may be confused with acquired cysts caused by infection or other pathologies. The thickness of cyst wall is salient differentiating point between benign bronchogenic cysts and other infection-related cysts. Knowledge of CT and radiographic finding is important for preoperative differential diagnosis and understanding of this special disease entity.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | St-Georges R, Deslauriers J, Duranceau A, Vaillancourt R, Deschamps C, Beauchamp G, et al. Clinical spectrum of bronchogenic cysts of the mediastinum and lung in the adult. Ann Thorac Surg 1991;52:6-13.  [ PUBMED] |
| 2. | Sidebotham E, Crabbe DC. Congenital lung malformations in infants. Infant J 2010;6:19-23. |
| 3. | David VL, Radulescu A, Popoiu MC. Congenital lung malformations. A review. J Pediatr 2006; IX: 35-6. |
| 4. | Yoon YC, Lee KS, Kim TS, Kim J, Shim YM, Han J. Intrapulmonary bronchogenic cyst: CT and pathologic findings in five adult patients. AJR Am J Roentgenol 2002;179:167-70. [ PUBMED] |
| 5. | Shanmugam G. Adult congenital lung disease. Eur J Cardiothorac Surg 2005;28:483-9. [ PUBMED] |
| 6. | Loving VA. Intrapulmonary bronchogenic cyst. Appl Radiol 2016;45:38-9. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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