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Case of the Month

by Dr K C Choy AM (Mal), MBBS, M.Med, FRCR

Answer to Case Of the Month 
The patient had a thoracotomy with removal of a thin walled cystic lesion in the right paratracheal region. The wall of the lesion was lined by a single layer of columnar epithelium some of which were ciliated. The histopathological diagnosis of bronchogenic cyst was made.

Discussion of Findings
There was a “bulge” and widening of the right paratracheal region on the CXR- indicating a mediastinal mass was likely. The CT of the thorax showed a low density lesion in the right paratracheal region, at about the level of the carina. There was no significant enhancement of the lesion or its wall.

Bronchogenic Cyst

Widening of the superior mediastinum on the CXR may be due to a variety of causes. Most commonly, this is due to enlarged lymph nodes from lymphoma, metastatic disease or sarcoidosis. Other causes include germ cell tumours, thymic tumours or retrosternal extension of a thyroid mass. Foregut developmental abnormalities such as bronchogenic cyst or duplication cyst are less common.

Bronchogenic cyst arises from an abnormality in the development of the primitive foregut. It is lined with respiratory epithelium and contains mucoid material. They may be located anywhere in the mediastinum but the middle mediastinum is the most common site especially in the subcarinal and right paratracheal areas. Less than 15% of cysts are located within the lung parenchyma.

Most brochogenic cysts are asymptomatic and discovered incidentally. They may become symptomatic if infection or haemorrhage or compression of adjacent structures occurs. On CXR, a bronchogenic cyst appears as a smooth lobulated mediastinal mass. On CT scan, the cyst is usually round with low attenuation contents. Some of the cysts may appear to have soft tissue attenuation due to proteinacious material or haemorrhage in the cyst. The cyst wall does not enhance with contrast.
 
About the Author 
Dr K C Choy is currently attached to the Mahkota Medical Centre, Melaka as Radiologist.

 
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Tuesday, 04 January 2005