Perinatal management of common neonatal thoracic lesions

Subcutaneous bronchogenic cyst of the chest wall: A case report with brief literature review

Introduction

Bronchogenic cysts are congenital lesions found in the mediastinum, particularly the posterior-superior area. The current study aims to report a rare case of a subcutaneous bronchogenic cyst in the chest wall.

Case report

A 41-year-old patient presented with a swelling of the chest wall. The mass had been present since birth. On examination, there was a large soft, round mass over the sternum subcutaneously. It was a fixed, non-flatulence, non-pulsatile, and non-tender mass.

Discussion

Usually, the condition develops between the fifth and sixteenth weeks of gestation, when the primordial intestine separates into two parts: dorsal, which gives rise to the esophagus, and ventral, which gives rise to the pulmonary bud and tracheobronchial tree. As a result, the cyst is an ectopic lung bud that may or may not be connected to the tracheobronchial tree but lacks mesenchymal tissue.

Conclusion

Although chest wall bronchogenic cysts are uncommon, they should be considered in the differential diagnosis of cystic and soft tissue lesions in adults with chest wall swelling.

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Bronchogenic cysts are congenital lesions.

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The majority are found in the mediastinum.

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Rarely they have been observed in the scapula, paravertebral, and cervical regions

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A chest wall bronchogenic cyst is an extremely rare condition

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This study reports a case of a subcutaneous bronchogenic cyst of the chest wall.

Prenatal diagnosis and postnatal findings of bronchogenic cyst

Bronchogenic cysts arise from abnormal buds from the primitive esophagus and tracheobronchial tree, which do not extend to the site where alveolar differentiation occurs. Bronchogenic cysts are typically unilocular mucus field lesions arising from posterior membranous wall of the air way. The prenatal diagnosis usually is realized by two-dimensional ultrasound showing the large unilocular cystic image in the chest fetus. The prenatal percutaneous aspiration can reduce the risk of heart compression and permit better respiratory conditions to newborn. We present a case of a primiparous pregnant 23 year-old-woman prenatal ultrasound showed a large unilocular cyst in the left hemithorax with compression of the normal left lung tissue and contralateral mediastinal shift. This cyst was percutaneously aspirated without subsequent reaccumulation of fluid. The newborn did not have respiratory distress and the computed tomography scan confirmed the finding of a fluid-filled cyst in the left chest. The chest X-ray showed the displacement of the heart and the mediastinum from the left to the right. The prenatal diagnosis of bronchogenic cyst is very important to assess the degree of the compression of the normal lung and the mediastinum shift. Furthermore, the prenatal diagnosis permits planning delivery in the tertiary hospital with multidisciplinary team because of the risk of respiratory distress.