Authors: Diarra BI, Doumbia M, Touré M, Keita F, Coulibaly B, Keita A, Touré AB, Daffe S, Sidibé A, Doucouré O, Coulibaly BM, Cissé M, Traoré K, Traoré S, Diallo B, Koita SS, Togola B, Togo S, Ouattara M A, Yena S, Fernandez G, Nadjeeboulah B, Flecher E, Langanay T, Amerin C, Boutin L, Deloche A.
Introduction: Bronchogenic cysts are congenital malformations of the homoplastic dysembryoma type, producing cavities lined with bronchial epithelium and containing air and/or mucoid material. Their location may be mediastinal (30-40% of cases) or intrapulmonary (60-70% of cases) [1]. Infection is one of the most frequent complications of these cysts. Infection may be secondary to common germs, and association with pulmonary tuberculosis is exceptional.
Observation: This 49-year-old patient was admitted to our department with an 08-month history of paroxysmal cough, mild dyspnoea on exertion and chest pain. Cardiovascular risk factors included smoking (45 pack-years), which had been weaned for 1 year.
The physical examination on admission was unremarkable. Tuberculosis workup, including sputum Genexpert and tuberculin intradermal reaction, was normal. Chest X-ray revealed a well-limited, round, homogeneous hydric opacity measuring 5cm long on the left paracardiac axis. Cardiac ultrasound revealed a left retroventricular mass partially limiting ventricular contractions.
A thoracic CT scan revealed a well-limited proximal liquid mass with poly-lobed contours, hypodense and non-enhanced after intravenous injection of contrast medium. The mass was biopsied and removed by left posterolateral thoracotomy. Postoperative management was straightforward.
Anatomopathological study of the surgical specimen revealed a cystic formation lined by a respiratory-type lining in the process of necrosis. This was fibrosis with foci of cartilage and lymphoid tissue. Overall, the histological appearance was consistent with a brochogenic cyst.
Conclusion: Bronchogenic cysts are rare congenital malformations, which can remain asymptomatic for a long time. The main complications are compression of mediastinal organs, superinfection, intracystic haemorrhage or, exceptionally, malignant degeneration. Surgery remains the best therapeutic option.
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