A 45-year-old man presented with a 2-month history of cough and hemoptysis. Imaging showed a 7x7.5x6 cm lobulated cystic lesion in the left lower lobe with surrounding consolidation. CT findings were suggestive of an infected bronchogenic cyst. Bronchogenic cysts are congenital malformations that result from aberrant embryological budding of the tracheobronchial tree. They typically appear on imaging as well-defined smooth lesions and can become infected, leading to symptoms like cough.

1. Dr. Teffy Jose Prof.Dr.DHANDAPANI’S UNIT

2. 45 yr old , Mr.Ibrahim ,came with c/o 2 months cough with expectoration 1 episode of hemoptysis o/e afebrile PR- 82/mt BP-120/80 mmhg CVS –S1 S2 + RS -clear

4. CXR –PA view; Adequate penetration ; Trachea in midline ; Bone and soft tissues normal; ‘well defined smooth bordered radio opaque lesion seen in the left lower zone with lobular contour ‘ ‘lateral superior &inferior borders are well defined ‘ ‘left heart border is seen through the opacity ‘ ‘descending thoracic aorta is obscured by the opacity IMP; suggestive of homogenous opacity located posteriorly

6. The lateral x ray confirmed the posterior location of the opacity X ray wise this could thought of as a mediastinal mass / solitary pulmonary opacity > 4 cm size the diff.diag of which is _bronchial carcinoma _lung abscess _wegener’s granulomatosis _lymphoma _round pneumonia

8. Ct picture

11. CT shows: 7*7.5*6 cm sized lobulated non enhancing cystic density lesion of 0-25 HU noted in posterobasal segment of left lower lobe. The lesion shows surrounding consolidatory changes with air bronchogram IMP:Infected bronchogenic cyst with consolidation in the left lower lobe

13. Bronchogenic cyst “ During development a portion of the tracheo bronchial tree gets separated “ Can be ----- a)pulmonary b) mediastinal 10-15% 65-90% Radiology ; sharply demarcated round /oval, nodule /mass, usually in the medial 1/3 of lungs with a lower lobe predilection usually don’t communicate with the tracheobronchial tree unless infected

14. Ct findings Non enhancing homogenous opacity With attenuation density approximately of water 0-20 HU With smooth thin wall Sometimes the density may be high due to varied contents with high protein or calcium MRI is superior to CT in diagnosing

15. Mediastinal bronchogenic cysts five types -paratracheal -carinal -hilar -paraeosophageal -miscellaneous -thymus,pericardium etc ,

16. Clinical picture Usually asymptomatic When infected may present with cough and sputum production Hemoptysis is also a common presenting feature Rarely complications like pneumothorax air emoblism adenocarcinoma

17. Thank you