Bronchogenic Cyst in Association Hypoplasia of the Left Pulmonary By Albert

C. Selke,

Jr.,

Robert

P. Belin, and

Robert

With Artery Durnin

B

RONCHOGENIC CYSTS are congenital foregut anomalies which ma) cause significant respiratory symptoms in infants and children.‘.3 ’ Compression of the tracheobronchial tree can lead to overinflation, atelectasis and life-threatening respiratory disease. The case presented is unique in that it was associated with hypoplasia of the left pulmonary artery. CASE

REPORT

M.E. was admitted to the University of Kentucky Medical Center at age 4 yr for evaluation of chronic cough. The prenatal, preinatal. and developmental history was unremarkable. Physical examination and routine laboratory studies on admission were normal. P.A. and lateral chest radiographs (Fig I A, B) revealed the presence of a large left mid-mediastinal mass. Oligemia of the left lung was noted with exaggeration of the right pulmonary vessels. A barium swalloa demonstrated displacement of the esophagus to the right (Fig. 2). Cardiac catheterization revealed a normal main pulmonary artery pressure and no intracardiac anomalies. A pulmonary angiogram (Fig. 3) demonstrated preferential blood flow to the right lung with markedly diminished perfusion of the left lung. Because of the apparent envelopment of the left pulmonary artery by the mediastinal mass, a neoplasm was suspected preoperatively. At operation, a 5 x 5-cm cystic mass was removed. The cyst arose from the left main stem bronchus in close proximity to the carina and impinged on the left pulmonary artery which al?peared to be hypoplastic. The pathologic specimen was noted to be a cyst lined with ciliated pseudo-stratified columnar epithelium and, therefore, was considered to be a bronchogenic cyst. Repeat pulmonary arteriogram 6 wk after surgery revealed no appreciable change In the diminuative left pulmonary artery. Follow-up chest radiographs at variable intervals up to 2 yr after surgery revealed preferential Row to the right lung with persisting hypoplasia of the left pulmonary arterial vasculature. DISCUSSION

Bronchogenic mediasinal cysts usually arise from a bronchus in the area of the carina, although they may occasionally be found in the posterior mediastinum. The majority are asymptomatic and are identified in the third to fifth decade as an incidental finding of a mediastinal mass on chest radiographs. The masses are most frequently homogeneous, however, and have at times shown liquid calcium within the cyst’ or linear calcification within the cyst walk6 The cyst may present symptoms by rupture, hemorrhage or as a focus of infection. More commonly, however, the symptoms, when present. are related to bronchial compression and are manifest by cough, wheezing, or stridor. In such patients, the presence of a juxtacarinal mass on chest radiographs should From Surgery

the Department Universit.v

Address

Jar

oJ Diagnostic requests:

Albert

Leuington.

121197.5 bv Grune & Stratton,

of Pediatric

and Department

of Kentucky School of Medicine. Lexington.

reprint

Universit_v o,f Kentucky,

Journal

Radiology

Surgery,

C. Selke.

Jr.,

M.D.,

of Surgery.

Division

of

Pediatric,

K!. 40506. Albert

B. Chandler

Medical

Center.

KY.. 40506.

Inc

Vol. 10, No. 4 (August),

1975

541

542

SELKE,

BELIN,

Fig. 1. (A, B) P.A. and lateral radiographs of the chest prior to operation, the large left middle mediastinal mass with oligemic, hyperlucent left lung.

AND DURNIN

demonstrating

Fig. 2. Esophagram in P.A. projection revealing displacement of the barium-filled esophagus to the right.

BRONCHOGENIC

CYST

543

Fig. 3. Selected radiograph from a pulmonary angiogram demo nstrating the hypoplasia of the left pulmonary artery.

suggest

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