Imaging: Bronchogenic Cyst

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Imaging: Bronchogenic Cyst

  1. 1. Dr. Teffy Jose Prof.Dr.DHANDAPANI’S UNIT
  2. 2. <ul><li>45 yr old , Mr.Ibrahim ,came with </li></ul><ul><li>c/o </li></ul><ul><li>2 months cough with expectoration </li></ul><ul><li>1 episode of hemoptysis </li></ul><ul><li>o/e </li></ul><ul><li>afebrile </li></ul><ul><li>PR- 82/mt </li></ul><ul><li>BP-120/80 mmhg </li></ul><ul><li>CVS –S1 S2 + </li></ul><ul><li>RS -clear </li></ul>
  3. 4. <ul><li>CXR –PA view; Adequate penetration ; </li></ul><ul><li>Trachea in midline ; </li></ul><ul><li>Bone and soft tissues normal; </li></ul><ul><li>‘well defined smooth bordered radio opaque lesion seen in the left lower zone with lobular contour ‘ </li></ul><ul><li>‘lateral superior &inferior borders are well defined ‘ </li></ul><ul><li>‘left heart border is seen through the opacity ‘ </li></ul><ul><li>‘descending thoracic aorta is obscured by the opacity </li></ul><ul><li>IMP; suggestive of homogenous opacity </li></ul><ul><li>located posteriorly </li></ul>
  4. 6. <ul><li>The lateral x ray confirmed the posterior location of the </li></ul><ul><li>opacity </li></ul><ul><li>X ray wise this could thought of as a mediastinal mass / solitary pulmonary opacity > 4 cm size the diff.diag of which is </li></ul><ul><li>_bronchial carcinoma </li></ul><ul><li>_lung abscess </li></ul><ul><li>_wegener’s granulomatosis </li></ul><ul><li>_lymphoma </li></ul><ul><li>_round pneumonia </li></ul>
  5. 8. Ct picture
  6. 11. <ul><li>CT shows: </li></ul><ul><li>7*7.5*6 cm sized lobulated non enhancing cystic density lesion of 0-25 HU noted in posterobasal segment of left lower lobe. </li></ul><ul><li>The lesion shows surrounding consolidatory changes with air bronchogram </li></ul><ul><li>IMP:Infected bronchogenic cyst with consolidation in the left lower lobe </li></ul>
  7. 13. Bronchogenic cyst <ul><li>“ During development a portion of the tracheo bronchial tree gets separated “ </li></ul><ul><li>Can be ----- a)pulmonary b) mediastinal </li></ul><ul><li>10-15% 65-90% </li></ul><ul><li>Radiology ; </li></ul><ul><li>sharply demarcated round /oval, nodule /mass, </li></ul><ul><li>usually in the medial 1/3 of lungs </li></ul><ul><li>with a lower lobe predilection </li></ul><ul><li>usually don’t communicate with the tracheobronchial </li></ul><ul><li>tree unless infected </li></ul>
  8. 14. Ct findings <ul><li>Non enhancing homogenous opacity </li></ul><ul><li>With attenuation density approximately of water 0-20 </li></ul><ul><li>HU </li></ul><ul><li>With smooth thin wall </li></ul><ul><li>Sometimes the density may be high due to varied contents with high protein or calcium </li></ul><ul><li>MRI is superior to CT in diagnosing </li></ul>
  9. 15. <ul><li>Mediastinal bronchogenic cysts </li></ul><ul><li>five types </li></ul><ul><li>-paratracheal </li></ul><ul><li>-carinal </li></ul><ul><li>-hilar </li></ul><ul><li>-paraeosophageal </li></ul><ul><li>-miscellaneous </li></ul><ul><li>-thymus,pericardium etc , </li></ul>
  10. 16. Clinical picture <ul><li>Usually asymptomatic </li></ul><ul><li>When infected may present with cough and sputum production </li></ul><ul><li>Hemoptysis is also a common presenting feature </li></ul><ul><li>Rarely complications like </li></ul><ul><li>pneumothorax </li></ul><ul><li>air emoblism </li></ul><ul><li>adenocarcinoma </li></ul>
  11. 17. Thank you

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