Daily Archive 27.11.2019

Bronchogenic cysts

Pathological anatomy of bronchogenic cysts

Bronchogenic cysts are a malformation. As a rule, they are single-chamber, ovoid or rounded. The thickness of the cyst wall is not more than 5 mm, inside it is shiny, lined with a multi-row cylindrical epithelium, often ciliary. The structure of the wall repeats the structure of the normal wall of the trachea or bronchus – loose connective tissue, mucous glands, hyaline cartilage, but the wall of the cyst can be represented only by any one tissue. The average size of the cyst is 6-10 cm. Most bronchogenic cysts have a radical localization, are adjacent to one of the main or lobar bronchi. Often, cysts are located in the area of ​​Karina, often associated with the anterior wall of the esophagus, they can cause compression of the trachea and bronchi. Paratracheal cysts are attached to the tracheal wall on the right near the bifurcation. Bronchogenic cysts can be located parapericardially, paraesophageally, in the wall of the esophagus, as well as in any part of the mediastinum.

Clinic of bronchogenic cysts

Bronchogenic cysts are often asymptomatic. Clinically characterized by symptoms of compression of the trachea and large bronchi, sometimes the esophagus. Noisy breathing, wheezing, shortness of breath, cough, dysphagia, chest pain are the most common symptoms. With a complicated course – suppuration of the cyst, breakthrough of purulent contents in the bronchi, trachea – there may be a fever, purulent intoxication, hemoptysis, purulent sputum, aspiration pneumonia, chronic bronchitis. Possible malignancy. Physical data are nonspecific.

Diagnosis of bronchogenic cysts

Radiologically, the cyst is a smooth, round or oval darkening of medium intensity. The vertical dimensions prevail over the horizontal, the contours are clear. The inner surface of the dimming is intimately connected with the trachea and bronchi, rarely a leg is found that goes to the trachea or bronchus. Changing the shape of the cyst during breathing and the displacement of the cyst associated with the trachea when swallowing are functional radiological symptoms. When contrasting the esophagus, its displacement or compression can be detected. The presence of a fluid level indicates a message with the bronchus or trachea. X-ray CT expands the capabilities of the X-ray method, allows you to reliably differentiate the cyst from tumor formation, establish the relationship of the cyst with surrounding organs.
With an intimate connection with the trachea and bronchi, tracheobronchoscopy is indicated both for the purpose of differential diagnosis and for the purpose of establishing the degree of inflammatory changes in the wall of organs. Due to the possibility of infection, a transtracheal or transbronchial puncture biopsy is not indicated.
A differential diagnosis should be carried out with lung neoplasms, teratomas, neurogenic mediastinal tumors, coelomic cysts, paramediastinal pleurisy.

Treatment of bronchogenic cysts

Surgical treatment. Possible complications and malignancy determine the active tactics.