Figure 1a

                                                Figure 1b






Bronchogenic cyst is a congenital cystic lesion arising from embryonic out-pouching of the foregut or trachea. Although relatively uncommon, it represents the second most common subtypes of foregut cysts (7-15%) found in the middle mediastinum, with a reported prevalence of 1 in 68,000 population. There is no sex predilection and over 50% are found in patients over the age of 15 years.


60% of all bronchogenic cysts are found in the mediastinum, 30% intrapulmonary and 10% in the hilar region. Histologically, bronchogenic cyst is lined by respiratory epithelium. Occasionally gastric mucosa or bronchial cartilage may be present.


The clinical presentation of bronchogenic cyst is variable depending on the size of the cyst, from respiratory distress at birth to late appearance of compressive symptoms such as chest pain and dysphagia in adults. Infection of the cystic fluid results in repeated pulmonary infection. Other symptoms included superior vena cava obstruction, pleurisy and pneumonia.


Bronchogenic cysts are diagnosed prenatally in 70% of cases using ultrasound. Chest radiographs (PA & Lateral) typically shows a sharply demarcated smooth spherical lesion commonly located in the middle mediastinum. CT scan or MRI will clearly defined the cystic nature of the lesions with thin wall (Figure 1a). However in some cases, diagnosis is only confirmed with biopsy or aspiration of the lesion (Figure 1b).


Surgical excision is recommended for all symptomatic bronchogenic cysts. In newborns with asymptomatic bronchogenic cysts, surgical intervention is recommended at age 3-6 months, to allow for compensatory lung growth. VATs excision has the advantages of less pain, better cosmesis and early discharge. Temporising procedures such as VATs or transbronchial aspiration may be recommended in patients not fit for formal excision.


Images contributed by Mr Chong Chee Fui, Department of General Surgery (Thoracic Unit), RIPAS Hospital, Brunei Darussalam.

All images are copyrighted and property of RIPAS Hospital.