gms | German Medical Science

Background: Bronchogenic cysts are mostly benign, congenital foregut malformations. They can be found in any organ, but most frequently in the chest cavity, especially mediastinal and intrapulmonary. Most patients are asymptomatic. We present a case of a subcarinal bronchogenic cyst with a rare clinical presentation.

Materials and methods: A 30-year-old man was admitted to the cardiology department of our hospital with a first episode of symptomatic atrial fibrillation. After undergoing a successful ablation therapy, he complained of dry cough and had hemoptysis once. He was referred to the department of thoracic surgery. Physical examination was normal. His weight was 100kg at 185cm. The patient’s medical history revealed no abnormalities. CT-scan of the chest was performed and showed a round, subcarinal, well-circumscribed structure with water attenuation compressing the tracheal bifurcation. The suspected diagnosis of a bronchogenic cyst was made.

Results: 12 days after admission we performed a posterolateral thoracotomy on the right side and resected the subcarinal cyst of which the dorsal part was fusing with the tracheal bifurcation. The bifurcation was covered and augmented by a pediculated pericardial flap. The procedure was completed by dissecting local lymph nodes. On the second and thirteenth postoperative day a re-do had to be performed due to bleeding and hemothorax under full anticoagulation as recommended by the cardiologists. The final histology confirmed the diagnosis of a bronchogenic cyst. The dry cough disappeared gradually after surgery. At last follow-up, 5 years later, our patient was asymptomatic and was fully integrated back into his professional and personal life.

Conclusion: Bronchogenic cysts are the most common congenital foregut cysts and account for approximately 60% of all mediastinal cysts. Most of the cysts occur in the middle mediastinum. They are often found in young adults in the third decade of life. Patients with bronchogenic cysts may present with compressive symptoms, or they may be asymptomatic and incidentally discovered on imaging studies. However, the clinical presentation of our patient is absolutely rare.