J Thorac Cardiovasc Surg 1998;116:372-373
© 1998 Mosby, Inc.
Isolated bronchogenic cyst of the lower mediastinum
Alessandro Brunelli, MD,
Majed Al Refai, MD,
Aroldo Fianchini, MD
To the Editor:
In a previous issue of the Journal, Ribet, Copin, and Gosselin
1 described symptoms, locations, and treatments of bronchogenic cysts of the mediastinum. These cysts are an anomaly of the bronchial development from the primitive ventral foregut that arises from cells isolated from the main pulmonary branches when the lung bud separates from the primitive gut.
We recently operated on a 60-year-old symptom-free woman who had a tumor of the posteroinferior mediastinum evident on a chest x-ray film. A radiogram taken 5 years earlier showed no abnormalities. Computed tomographic scan of the chest confirmed the presence of a lesion located in the left paravertebral region adjacent to the descending aorta.
The mass was interpreted as a neurogenic tumor and a magnetic resonance imaging scan was obtained to assess the relationship with the intervertebral foramina. This latter examination showed a high signal intensity image, which was interpreted as indicating a cystic neurogenic lesion (i.e., neuroenteric cyst, anterior meningocele, or other neurogenic tumors; Figs. 1 and 2). The patient was operated on through a left lateral thoracotomy. The tumor appeared cystic and translucent, with a thin wall, overlying the lateral aspect of the descending aorta at a juxtadiaphragmatic level. No contact or continuity with the trachea, pulmonary hilum, or esophagus was present, and the excision was straightforward.
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Fig. 1. Magnetic resonance image of the left laterovertebral region showing a high-intensity lesion adjacent to the descending aorta.
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Fig. 2. Sagittal magnetic resonance image shows the relationship between the tumor and the descending aorta at a juxtadiaphragmatic level.
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Histologic examination revealed a ciliated columnar mucosal lining with smooth muscles and bronchial glands. The content of the cyst was clear and sterile mucus. Thus the lesion was diagnosed as a bronchial cyst of the mediastinum.
Even though bronchial cysts of the lower mediastinum and also of the subdiaphragmatic region have occasionally been reported, they have generally been associated with the trachea, carina, hilum, or esophagus. 2 The peculiarity of our case is that the cyst was not related to the above-mentioned structures. It appeared indeed related to the parietal pleura overlying the descending aorta.
The tumor in our case was similar in location to the tumors in two of the adults whom Ribet, Copin, and Gosselin 1 described. These tumors were preoperatively mistaken for neurogenic tumors because of their laterovertebral location, even though they were anterior to the foramen. This atypical location can create diagnostic problems despite modern imaging modalities such as computed tomographic scanning and magnetic resonance imaging 3 and has to be taken into consideration in the differential diagnosis of tumors of the laterovertebral sulcus.
Department of Thoracic SurgeryUniversity of Ancona School of Medicine,
Via S. Margherita 23,
Ancona 60129, Italy12/8/90504
References
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Ribet ME, Copin MC, Gosselin B. Bronchogenic cysts of the mediastinum. J Thorac Cardiovasc Surg 1995;109:1003-10.[Abstract]
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St. Georges R, Deslauriers J, Duranceau A, et al. Clinical spectrum of bronchogenic cysts of the mediastinum and lung in the adult. Ann Thorac Surg 1991;52:6-13.[Abstract]
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Brasch RC, Gooding CA, Lallemand DP, Wesberg GE. Magnetic resonance imaging of the thorax in childhood. Radiology 1984;150:463-7.[Abstract/Free Full Text]
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