Bronchogenic Cyst

What is a bronchogenic cyst?

Bronchogenic cysts are masses that develop from abnormal development of the bronchial tree, the network of airways that supplies air to the lungs. Bronchogenic cysts usually form when parts of the bronchial tree abnormally bud off during the fourth to sixth weeks of development in infancy, however, the specific cause is not known.

Symptoms in infants include difficulty breathing or feeding and blue skin. Other symptoms that are likely later in life include coughing and wheezing, recurrent lung infections, trouble swallowing, hoarseness, a mass in the neck, and a complication known as a pneumothorax (partial lung collapse) which presents as severe chest pain and difficulty breathing.

Treatment modalities include surgery, aspiration of the cyst’s contents with a needle, antibiotics, and other supportive treatments.

You should visit your primary care physician, as surgical treatment is needed for bronchogenic cysts.

Bronchogenic cyst symptoms

Main symptoms

Most cases of bronchogenic cysts do not cause symptoms until your child is a teenager or young adult. However, some cases can cause symptoms as an infant. The main symptoms of bronchogenic cysts include:

• Difficulty breathing or feeding as an infant: This may occur in cases of bronchogenic cysts that grow rapidly and compress the lungs or the gastrointestinal system.
• Blue-colored skin as an infant: Some infants with bronchogenic cysts may develop blue-colored skin, or “cyanosis.” This can occur if the bronchogenic cyst is preventing the infant from breathing normally, which reduces the amount of oxygen in the blood.
• Coughing and wheezing: Most cases of bronchogenic cysts will cause recurrent episodes of coughing and wheezing in a teenager or young adult. Wheezing is a high-pitched sound that can be heard when a person is breathing out. This can occur from the bronchogenic cyst compressing the lungs, or if the bronchogenic cyst or lungs become infected.
• Recurrent lung infections: This may cause symptoms such as fever, shortness of breath, coughing, and sputum production. This can occur if the bronchogenic cyst compresses part of the lung, predisposing it to infection by bacteria, or if the bronchogenic cyst itself becomes infected and the infection spreads to the lungs.

Other symptoms

Other symptoms and possible complications of bronchogenic cysts that may develop in some people include the following.

• Trouble swallowing: This can occur if the bronchogenic cyst compresses the esophagus, which is the structure that food travels through to get to the stomach.
• Hoarseness: This can occur if the bronchogenic cyst compresses nerves in the neck that are important for the normal functioning of the voice box.
• Sudden chest pain and difficulty breathing: One complication of bronchogenic cysts is a condition called pneumothorax in which air collects in the chest cavity and causes part of the lungs to collapse. This can occur if a bronchogenic cyst within the lung ruptures and allows air to enter the chest cavity. A pneumothorax will cause sudden-onset difficulty breathing as well as chest pain. The chest pain usually feels sharp and may be worse when breathing in.
• Mass in the neck: The mass is usually not painful.

Bronchogenic cyst causes

The specific cause of bronchogenic cysts is unknown. Depending on where the bronchogenic cyst buds off from, it may be found in a number of locations, however, cysts are usually located in the lungs or the center of the chest. The bronchogenic cysts are usually not connected to the airways and are usually filled with fluid, proteins, and other materials rather than air.

• In the middle of the chest (mediastinum): The majority of bronchogenic cysts are located in the middle of the chest in a region known as the mediastinum, which contains the heart, a number of large blood vessels, and other important structures.
• In the lung tissue: The second most common location for bronchogenic cysts is within the lung tissue. These are known as parenchymal or intrapulmonary bronchogenic cysts. These types of bronchogenic cysts are usually located in the lower part of the lungs.
• In other locations: In rare cases, bronchogenic cysts may be located in other locations such as the neck, skin, lining of the heart, or in the abdomen.

Treatment options and prevention for bronchogenic cyst

Surgery

The most effective way to fully treat a bronchogenic cyst is to remove it using a surgical procedure. Surgery may involve removing part of the lungs if the bronchogenic cyst is located partly in the lung tissue. The surgery will usually be done through an incision on the side of the chest.

Needle aspiration

In some cases of bronchogenic cysts, the doctor may recommend a procedure that uses a needle to remove fluid from the cyst. The needle can be inserted either through the skin or through a tube that is passed into the lungs from the mouth. Removing the fluid from the bronchogenic cyst may temporarily relieve symptoms caused by the cyst compressing adjacent structures. However, because the wall of the cyst is not removed, the bronchogenic cyst may refill with fluid at a later time and require repeat treatment.

Antibiotics

If the bronchogenic cyst becomes infected or causes a lung infection, the doctor may recommend a course of antibiotic medications to treat the infection. The specific antibiotic may vary depending on the patient’s risk factors and the specific organisms causing the infection, but may include azithromycin (Zithromax), levofloxacin (Levaquin), ceftriaxone (Rocephin), vancomycin, or piperacillin-tazobactam (Zosyn), among others.

Respiratory support for infants with difficulty breathing

Infants with bronchogenic cysts who develop difficulty breathing may require respiratory support until the bronchogenic cyst can be removed. This may include giving supplemental oxygen through a tube or mask or intubating the infant to protect his or her airway.

Treatment for pneumothorax

If anyone with a bronchogenic cyst develops a pneumothorax, he or she may require treatment for the pneumothorax. Treatment for a pneumothorax varies depending on the severity of the pneumothorax, and may including giving supplemental oxygen, inserting a needle into the chest to remove the air, and/or placing a chest tube within the chest to prevent the air from re-accumulating.

When to seek further consultation for bronchogenic cyst

If you or your child develops any symptoms of a bronchogenic cyst such as difficulty breathing, recurrent coughing and wheezing, recurrent lung infections, or a mass in the neck, you should go see your doctor. Your doctor can order imaging studies to determine if you or your child has a bronchogenic cyst, and then offer the appropriate treatments.