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Condition: Bronchogenic Cysts
Overview: ("What is it?")
- Definition: A cyst is a round closed sac or pouch usually present at birth arising from the airways of the lungs. They are usually located close to the windpipe (also known as the trachea) (Figure 1) or major airways branching to the lung (known as the bronchus).
- Bronchogenic cysts form when small portions the developing trachea and lung pinch off and become separated from the airways.
- Bronchogenic cysts are usually, but not always, outside of the lung. They do not communicate with the normal airways. In addition, bronchogenic cysts do not contain air sacs (alveoli). Alveoli are the main areas of the lung where oxygen and carbon dioxide are exchanged.
Signs and Symptoms ("What symptoms will my child have?")
- These rare cysts often have no symptoms.
- They may be seen on ultrasound of a developing baby in the uterus or as an unexpected finding on a chest X-ray.
- Bronchogenic cysts located in the area where the main windpipe branches between the right and left airways can sometimes cause pressure on the trachea resulting in breathing problems in newborns.
- Possible symptoms are wheezing, noisy breathing, turning blue in color (cyanosis), breathing problems, chronic cough or chest pain.
- Long-term complications can include coughing blood due to cyst eroding through surrounding tissues (hemoptysis), infection and the development of cancer (very rare).
- These cysts can be found at any age depending on size, location and presence of symptoms.
Diagnosis ("What tests are done to find out what my child has?")
- They may be detected on chest X-ray, MRI or CT scan of the chest.
- Fifteen percent of bronchogenic cysts are found within the lung (intrapulmonary cysts). They appear as round or oval-shaped, fluid-filled or air-filled cysts. The size can vary widely. Usually they are single in number and approximately two-thirds are in the lower lobes. Cysts may also appear as a combination of air and fluid in the chest that may be suspicious for an infection.
Figure 1 (Image provided by Dr. Marion Henry, Naval Medical Center San Diego, California)
- 85% of bronchogenic cysts are found along the trachea or bronchus In these areas, they also appear as single, round or oval-shaped fluid- or air-filled cysts. Occasionally they can cause compression of the airways.
- A bronchoscope is a fiber-optic camera that is inserted in the airways to identify such cysts that still communicate to the airway. Using a bronchoscope usually requires anesthesia. Those cysts that compress the trachea or bronchus can also be seen on bronchoscopy.
Treatment ("What will be done to make my child better?")
- Medicine: No medical treatment is able to remove or shrink the cyst. If the cyst is infected, medicines to treat the infection (antibiotics) may be needed.
- Surgery: Symptomatic cysts should be removed with surgery. Most bronchogenic cysts can be removed using open (called thoracotomy) versus minimally invasive (thoracoscopy) techniques. Open surgery means a larger incision between the ribs to remove the cyst. Thoracoscopy means using a camera, telescope and instruments through small incisions to perform the surgery. Thoracoscopy may be contraindicated in children with cysts under the carina. In some cases, it is extremely difficult to separate the wall of the cyst from the normal airway without causing damage to the airway. Near-complete removal and leaving the attached portion of the cyst wall on the airway is reasonable treatment and has not been associated with recurrence.
- Asymptomatic cysts should also be removed because of the risk of infection.
- Risks for surgery are low but include bleeding, infection, collapsed lung, air leakage from the airways and risks of anesthesia.
- Usually, after the surgery a tube to drain air and fluid from the chest cavity is needed for a few days. This tube will be removed prior to discharge.
Figure 2 (Image provided by Dr. Marion Henry, Naval Medical Center San Diego, California)
Home Care (“What do I need to do once my child goes home?”)
- Diet: Your child may eat a normal diet after surgery.
- Activity: Your child should avoid strenuous activity and heavy lifting for the first 1-2 weeks after thoracoscopic surgery, 4-6 weeks after open surgery.
- Wound care: Surgical incisions should be kept clean and dry for a few days after surgery. Most of the time, the stitches used in children are absorbable and do not require removal. Your surgeon will give you specific guidance regarding wound care, including when your child can shower or bathe.
- Medicines: Medicines for pain such as acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) or something stronger like a narcotic may be needed to help with pain for a few days after surgery. Stool softeners and laxatives are needed to help regular stooling after surgery, especially if narcotics are still needed for pain.
- What to call the doctor for: Call your doctor for worsening pain, fever, breathing problems or if the wounds are red or draining fluid.
- Follow-up care: Your child should follow up with his or her surgeon 2-4 weeks after surgery to ensure proper post-operative healing.
- Complications: Wound infections may need only antibiotics or may require opening up of the wound depending on how bad the infection is.
Long-Term Outcomes ("Are there future conditions to worry about?")
After surgical treatment, the long-term prognosis is excellent.
Author: Romeo C. Ignacio, Jr., MD
Editors: Patricia Lange, MD; Marjorie J. Arca, MD