OVERVIEW

What causes congenital bronchogenic cysts?

Congenital bronchogenic cysts result from abnormal development of the respiratory system during the embryonic stage.

Where do congenital bronchogenic cysts commonly occur?

Depending on the developmental stage, lesions can occur at different sites of the bronchial tree.

What types of congenital bronchogenic cysts exist?

Based on the lesion location, they are classified into mediastinal, intrapulmonary, and heterotopic types.

Are congenital bronchogenic cysts common?

Congenital bronchogenic cysts are not rare clinically but are often misdiagnosed.

SYMPTOMS

What are the manifestations of congenital bronchogenic cysts?

The clinical symptoms of bronchogenic cysts can range from mild to severe, often lacking specificity, and may even be asymptomatic with no physical signs. Sometimes, they provide no clear clues for diagnosis and are frequently discovered during routine examinations. Alternatively, they may only be detected as the lesion enlarges with age, causing compression symptoms or infection.

Symptoms usually arise due to secondary infections or compression of surrounding tissues or organs by the cyst, such as cough, sputum production, hemoptysis, chest tightness, dyspnea, chest pain, swallowing discomfort, and fever. Newborns with rapidly enlarging central cysts may experience respiratory distress, cyanosis, and feeding difficulties.

What are the consequences of congenital bronchogenic cysts?

Cyst compression can lead to airway obstruction, resulting in symptoms like chest tightness, shortness of breath, and wheezing, while also increasing the risk of pulmonary infections.

CAUSES

What are the causes of congenital bronchogenic cysts?

Congenital bronchogenic cysts are actually a type of congenital anomaly, mostly caused by abnormalities during embryonic development.

DIAGNOSIS

What tests are needed to diagnose congenital bronchogenic cysts?

Chest X-ray and CT scans have certain diagnostic value for intrapulmonary and mediastinal bronchogenic cysts.

The lesions may appear as water-density shadows. If there is hemorrhage within the cyst, extensive fibrous tissue hyperplasia, or granuloma formation, soft tissue-density shadows may be observed. Most lesions are round or oval, with uniform density and clear boundaries. Signs of surrounding exudation may be seen if infection is present.

If the cyst communicates with the bronchus and air enters, a cavity-like lesion forms. The cyst wall is thin, and the larger the cyst, the thinner the wall. In cases of infection, the wall may thicken and become blurred. Multiple cavities may present as honeycomb-like shadows. Long-standing lesions may show calcification. CT enhancement typically shows no significant contrast uptake.

Indirect signs often include atelectasis, which may result from bronchial compression causing obstructive atelectasis or volume reduction due to fibrous tissue traction. Additionally, there may be signs of compression on surrounding tissues or organs, such as esophageal displacement.

Which diseases are congenital bronchogenic cysts easily confused with?

Diseases requiring differentiation:

• Lung cancer: Mostly occurs in elderly patients, with irregular lesion margins, lobulation, and spiculation. Tumor markers and pathological examination confirm lung cancer.
• Bronchiectasis: Recurrent cough, purulent sputum, often accompanied by hemoptysis, with more pronounced symptoms than bronchogenic cysts. Imaging shows abnormal widening of bronchial lumens, multiple lesions. Diagnosis can be made via thin-slice CT, high-resolution CT, or bronchography.
• Tuberculous cavity: Presents with systemic tuberculosis symptoms, surrounding disseminated lesions, fibrosis, and thicker walls compared to bronchogenic cysts.
• Pulmonary bullae: Lesions are often located at the lung periphery, with thinner walls than bronchogenic cysts.
• Lung abscess: Symptoms include chills, high fever, and copious purulent sputum. Abscess walls are thicker than bronchogenic cysts and shrink after antibiotic treatment.
• Mediastinal tumors: Bronchogenic cysts are usually located in the middle mediastinum. Malignant mediastinal tumors have irregular contours and uneven density, while bronchogenic cysts have clear, regular contours and uniform density. Benign mediastinal tumors may also be easily confused.

TREATMENT

Does congenital bronchogenic cyst require hospitalization?

Congenital bronchogenic cysts require surgical treatment and are often complicated by pulmonary infection, necessitating hospitalization.

What are the treatment methods for congenital bronchogenic cyst?

• Surgical resection of the lesion is an effective treatment for bronchogenic cysts. Once diagnosed, surgery should be performed as early as possible, with complete removal of the cyst wall.
• If infection is present, aggressive anti-infection treatment is required before surgery.
• For mediastinal and ectopic types, cyst enucleation can be performed. For superficial intrapulmonary cysts, simple cyst excision or wedge resection may suffice. If the cyst is confined to a segment or lobe, segmentectomy or lobectomy is performed. For multiple cysts involving an entire lung, pneumonectomy may be necessary, but postoperative lung function must be closely monitored.
• Attention should also be paid to the relationship between the cyst and adjacent tissues/organs. If the cyst has a connection to the esophagus or tracheobronchial tree, both the cyst and the tract should be excised, followed by meticulous suturing and repair to reduce postoperative complications.

What severe consequences may occur if congenital bronchogenic cyst is left untreated?

Although congenital bronchogenic cysts are benign, they may lead to recurrent infections, hemorrhage, or compression of surrounding tissues/organs as they enlarge, potentially impairing cardiopulmonary function in severe cases.

What are the surgical complications of congenital bronchogenic cyst?

• Complete cyst resection is essential to prevent recurrence. If complete removal is unfeasible, electrocautery may be used to destroy residual tissue and reduce recurrence risk.
• For cysts within the esophageal wall, incomplete repair after excision may result in esophageal fistula.

Under what circumstances is esophageal resection and reconstruction required for congenital bronchogenic cyst?

• The cyst is massive and tightly adherent to the esophagus, making dissection difficult;
• The cyst is located within the esophageal wall with bleeding or difficult repair after removal;
• Suspected malignant transformation of an esophageal wall cyst.

Can congenital bronchogenic cyst recur after treatment?

Recurrence is possible if the cyst is not completely excised during surgery.

DIET & LIFESTYLE

What are the lifestyle precautions for patients with congenital bronchial cysts?

Asymptomatic cases have no impact on daily life or diet. Symptomatic and postoperative precautions depend on specific surgical circumstances; generally, diet remains unaffected.

PREVENTION

Can congenital bronchial cysts be prevented?

Congenital bronchial cysts are actually a congenital abnormality, mostly caused by abnormalities during embryonic development, and there is no specific prevention method.