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Cardiothoracic Surgery |

Bronchogenic and Esophageal Duplication Cysts in an Adult Patient With Hemoptysis

Philip Svigals*, MD; Carlos Kummerfeldt, MD; Nathaniel Piel, MD; Robert Miller, MD; Nicholas Pastis, MD
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Medical University of South Carolina, Charleston, SC


Chest. 2012;142(4_MeetingAbstracts):44A. doi:10.1378/chest.1371402
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Abstract

SESSION TYPE: Surgery Student/Resident Case Report Posters

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Bronchogenic and esophageal duplication cysts are congenital malformations of the bronchopulmonary foregut during embryonic development. In adults, these rare cysts are typically found incidentally in asymptomatic patients. Computed tomography, endoscopic ultrasound and magnetic resonance imaging can help differentiate these cysts from other mediastinal tumors and aid in the diagnosis by demonstrating characteristic locations and features of near water density. Due to the high risk of developing symptoms and complications such as cough, dyspnea, infection, airway compression or even tension pneumothorax, surgical resection of the cyst is considered first-line treatment even in the asymptomatic patient. We discuss a rare case of an adult presenting with hemoptysis who was found to have both a bronchogenic cyst and an esophageal duplication cyst.

CASE PRESENTATION: A 44 year old African American woman with a history of chronic obstructive pulmonary disease and a right hilar mass presumed to be a bronchogenic cyst presented with an episode of hemoptysis and right-sided chest pain. Her right hilar mass was followed for nine years by her pulmonologist. An MRI done upon admission showed two benign appearing cystic mediastinal lesions of the right chest. The largest of these was within the right medial infrahilar region abutting the azygo-esophageal recess and measured 5.0 x 4.9cm and the second lesion in the right paratracheal location measured 2.4 x 2.4 cm (Figure 1 & 2). The patient underwent bronchoscopy which showed no evidence of active bleeding. Cardiothoracic surgery was consulted and performed a right thoracotomy, removing these two cystic lesions. The pathology confirmed that the larger infrahilar cyst was a bronchogenic cyst and the smaller paratracheal cyst was an esophageal duplication cyst.

DISCUSSION: Our case describes the rare event of a patient presenting with both a bronchogenic cyst and an esophageal duplication cyst. In our presentation, we will discuss the etiology, clinical sequelae, diagnosis, and management of bronchogenic and esophageal duplication cysts in adults.

CONCLUSIONS: Our patient underwent two unique events during embryologic development of the foregut that likely occurred at 28 days during the time of cleavage of the respiratory and digestive tract. These events determined the anomalous location of these cellular components. To our knowledge, this is the first report in the literature that found both types of bronchogenic & esophageal duplication cysts in the same patient.

1) Patel SR, Meeker DP, Biscotti CV, Kirby TJ, Rice TW. Presentation and management of bronchogenic cysts in the adult. CHEST 1994;106:79-85.

2) Cioffi U, Bonavina L, De Simone M, Santambrogio L, Pavoni G, Testori A, Peracchia A. Presentation and surgical management of bronchogenic and esophageal duplication cysts in adults. CHEST 1998;113:1492-1496.

DISCLOSURE: The following authors have nothing to disclose: Philip Svigals, Carlos Kummerfeldt, Nathaniel Piel, Robert Miller, Nicholas Pastis

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Medical University of South Carolina, Charleston, SC

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