Bronchogenic cysts are small, solitary cysts or sinuses, most typically located in the region of the
suprasternal notch
The suprasternal notch, also known as the fossa jugularis sternalis, jugular notch, or Plender gap, is a large, visible dip in between the neck in humans, between the clavicles, and above the manubrium of the sternum.
Structure
The suprasternal ...
or behind the
manubrium.
Clinical features
These cysts are found most often in young adults and are rare in
infancy. The usual symptoms are the result of compression by the cyst, e.g., difficulty breathing or swallowing, cough, and chest pain. Malignant degeneration has been reported in these cysts on rare occasions. Bronchogenic cysts are usually found in the middle
mediastinum. Chest x-rays show a smooth density just in front of the
trachea
The trachea, also known as the windpipe, is a cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all air- breathing animals with lungs. The trachea extends from the ...
or main stem bronchi at the carinal level. When the cyst communicates with the tracheobronchial tree, the air-fluid level may be seen within the cyst.
CT scanning is useful in localizing these cysts.
Pathology
Bronchogenic cysts are formed in the 6th week of
gestation from an abnormal budding of the tracheal
diverticulum. They are lined by respiratory type (ciliated) epithelium, which is characterized by
cilia. Histologically these are also composed of
cartilage,
smooth muscle, fibrous tissue and mucous glands.
These cysts originate from the ventral foregut that forms the respiratory system. These cysts are located close to the
trachea
The trachea, also known as the windpipe, is a cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all air- breathing animals with lungs. The trachea extends from the ...
or main stem
bronchi
A bronchus is a passage or airway in the lower respiratory tract that conducts air into the lungs. The first or primary bronchi pronounced (BRAN-KAI) to branch from the trachea at the carina are the right main bronchus and the left main bronchus. ...
. Rarely there is communication of the cyst with the tracheobronchial tree.
Treatment
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Excision provides definitive diagnosis and cure.
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Biopsy
A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a dise ...
provides a definitive diagnosis with less surgical risk.
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Observation provides minimal risk from the intervention, but carries some risk of bleeding or infection of the cyst at a later time, making excision more difficult if it occurs.
Additional images
Image:Cilia light micrograph.jpg, Very high magnification light micrograph showing the cilia of a bronchogenic cyst. H&E stain
Hematoxylin and eosin stain ( or haematoxylin and eosin stain or hematoxylin-eosin stain; often abbreviated as H&E stain or HE stain) is one of the principal tissue stains used in histology. It is the most widely used stain in medical diagnos ...
.
See also
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Cutaneous columnar cyst
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List of cutaneous conditions
References
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Cutaneous congenital anomalies