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Ann Thorac Surg 1991;52:6-13
© 1991 The Society of Thoracic Surgeons

Articles

Clinical spectrum of bronchogenic cysts of the mediastinum and lung in the adult

Régent St-Georges, MDa,b, Jean Deslauriers, MD*,a,b, André Duranceau, MDa,b, Rosaire Vaillancourt, MDa,b, Claude Deschamps, MDa,b, Gilles Beauchamp, MDa,b, Arthur Pagé, MDa,b, Jacques Brisson, MDa,b

a Centre de Pneumologie de Laval, Hôpital Laval, and Laval University, Ste-Foy, Canada
b University of Montréal, Hôtel-Dieu de Montréal, Hôpital Maisonneuve, and Hôpital du Sacré-Coeur de Cartierville, Montréal, Québec, Canada

* Address reprint requests to Dr Deslauriers, 2725 chemin Ste-Foy, Ste-Foy, Qué, Canada G1V 4G5.

Bronchogenic cysts are closed sacs considered to be the result of an abnormal budding of the respiratory system. They are lined by ciliated epithelium and have focal areas of hyaline cartilage, smooth muscle, and bronchial glands within their walls. They are seldom seen in the adult, and most are thought to be asymptomatic and free of complications. During a 20-year period, 86 patients underwent resection of a bronchogenic cyst of the mediastinum (66 patients) and lung (20 patients). There were 47 women and 39 men whose ages ranged from 16 to 69 years. Seventy-two percent of patients (67% with mediastinal cysts and 90% with cysts of the lung) were symptomatic at the time of operation, and the majority had two or more symptoms. Despite extensive investigations, which in some cases included computed tomographic scanning (n = 12) and angiography (n = 22), a positive diagnosis was never made preoperatively even if it was suspected in 57% of patients. In nearly all patients, the operative approach was that of a posterolateral thoracotomy. All but two mediastinal bronchogenic cysts could be locally excised, but all bronchogenic cysts of the lung required pulmonary resection (lobectomy, 13; limited resection, 6; pneumonectomy, 1). Major operative difficulties were encountered in 35 patients, all of whom were symptomatic preoperatively. Thirty-three patients had a complicated cyst; the complications consisted of fistulization (n = 16), ulcerations of the cyst wall (n = 13), hemorrhage (n = 2), infection without fistulization (n = 1), and secondary bronchial atresia (n = 1). Overall, 82% of patients had a bronchogenic cyst that was either symptomatic or complicated or both. Based on this information, we recommend that all presumed bronchogenic cysts seen in the adult be resected. This is even more important because operation can be hazardous when the cyst is symptomatic and definitive tissue diagnosis can only be established by means of surgical excision.




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