Radiographic Exhibit
epiphelium and filled with mucoid material. The typical lesion arises below the carina and extends posteriorly and inferiorly (1, 2, 4, 5). Because of its proximity to the esophagus, it is commonly seen as a smooth extrinsic pressure defect on the esophagus. It may even arise within the wall of the esophagus and therefore appear as an intramural extramucosal mass. As with bronchogenic cysts which communicate with the tracheobronchial tree, those that communicate with the esophagus most likely become infected first, followed by formation of a fistula. Reed and Sobonya (4) state that those cysts containing cartilage should be considered respiratory rather than gastroenteric in origin. Because the lesion in our patient contained cartilage, it was classified as a bronchogenic cyst of mediastinal origin. Although the preoperative diagnosis was uncertain, the subcarinal mid-posterior mediastinal location of the mass as well as its smooth inner borders strongly suggested the diagnosis of bronchogenic cyst.
Mediastinal Bronchogenic Cyst with Esophageal Communication 1 Robert Mindelzun, M.D., and
Pet~r
Long, M.D.
A bronchogenic cyst of the mediastinum with a fistulous communication with the esophagus was demonstrated on barium studies. INDEX TERMS: Esophagus, abnormalities. Mediastinum, cysts (Chest, bronchogenic cyst, 6 [0] .1441)
Radiology 126:28, January 1978
cysts are caused by budding abnormalities of the embryologic tracheobronchial tree. They may present in the pulmonary parenchyma, mediastinum, or even within or below the diaphragm. Communication with the esophagus has only been reported once in the available literature (3). We wish to report a case of mediastinal bronchogenic cyst communicating with the esophagus which was demonstrated on a barium study.
B
RONCHOGENIC
CASE REPORT Department of Radiology Santa Clara Valley Medical Center 751 S. Bascom Ave. San Jose, Calif. 95128
E.C., a 63-year-old woman, was admitted with a history of cough. chest pain. and progressive weight loss. On serial chest examinations (Figs. 1 and 2). she was found to have a smooth, round retrocardiac mass measuring 8 ern' with an air/fluid level. An esophagram demonstrated a 10-mm fistulous tract between the esophagus and the mass (Fig. 3). At left thoracotomy, a mass measuring 8.0 X 7.5 cm with a well-defined patent fistulous communication to the esophagus was resected. Microscopic examination revealed a saccular structure with a mucosal lining of pseudostratified columnar epithelium. Large bundles of smooth muscle were present in the fibrous wall of the mass. Hyaline cartilage was identified. as were nerves and blood vessels. The pathological diagnosis was mediastinal bronchogenic cyst.
REFERENCES 1. Bergstrom JF, Yost RV, Ford KT, et al: Unusual roentgen manifestations of bronchogenic cysts. Radiology 107:49-54. Apr 1973 2. Maier HC: Bronchiogenic cysts of the mediastinum. Ann Surg 127:476-502. Mar 1948 3. Moskal M, Kusmierski S: Torbiel oskrzelopochodna oproznlajaca sie do przelyku. Pol Przegl Chir 44:883-885, May 1972 [Pol] 4. Reed JC, Sobonya RE: Morphologic analysis of foregut cysts in the thorax. Am J RoentgenoI120:851-860. Apr 1974 5. Rogers LF, Osmer JC: Bronchogenic cyst. A review of 46 cases. Am J Roentgenol 91:273-283. Feb 1964
DISCUSSION Bronchogenic cysts are thin-walled cysts lined by respiratory
I
Figs. 1 and 2. Postero-anterior (1) and lateral chest radiographs (2) show a retrocardiac mediastinal mass containing air and fluid. Fig. 3. Spot film from the barium esophagram shows a fistulous communication (arrows) between the esophagus and the cystic mass.
1
From the Department of Radiology, Santa Clara Valley Medical Center, San Jose, Calif. Accepted for publication in August 1977.
28
sjh
epiphelium and filled with mucoid material. The typical lesion arises below the carina and extends posteriorly and inferiorly (1, 2, 4, 5). Because of its proximity to the esophagus, it is commonly seen as a smooth extrinsic pressure defect on the esophagus. It may even arise within the wall of the esophagus and therefore appear as an intramural extramucosal mass. As with bronchogenic cysts which communicate with the tracheobronchial tree, those that communicate with the esophagus most likely become infected first, followed by formation of a fistula. Reed and Sobonya (4) state that those cysts containing cartilage should be considered respiratory rather than gastroenteric in origin. Because the lesion in our patient contained cartilage, it was classified as a bronchogenic cyst of mediastinal origin. Although the preoperative diagnosis was uncertain, the subcarinal mid-posterior mediastinal location of the mass as well as its smooth inner borders strongly suggested the diagnosis of bronchogenic cyst.
Mediastinal Bronchogenic Cyst with Esophageal Communication 1 Robert Mindelzun, M.D., and
Pet~r
Long, M.D.
A bronchogenic cyst of the mediastinum with a fistulous communication with the esophagus was demonstrated on barium studies. INDEX TERMS: Esophagus, abnormalities. Mediastinum, cysts (Chest, bronchogenic cyst, 6 [0] .1441)
Radiology 126:28, January 1978
cysts are caused by budding abnormalities of the embryologic tracheobronchial tree. They may present in the pulmonary parenchyma, mediastinum, or even within or below the diaphragm. Communication with the esophagus has only been reported once in the available literature (3). We wish to report a case of mediastinal bronchogenic cyst communicating with the esophagus which was demonstrated on a barium study.
B
RONCHOGENIC
CASE REPORT Department of Radiology Santa Clara Valley Medical Center 751 S. Bascom Ave. San Jose, Calif. 95128
E.C., a 63-year-old woman, was admitted with a history of cough. chest pain. and progressive weight loss. On serial chest examinations (Figs. 1 and 2). she was found to have a smooth, round retrocardiac mass measuring 8 ern' with an air/fluid level. An esophagram demonstrated a 10-mm fistulous tract between the esophagus and the mass (Fig. 3). At left thoracotomy, a mass measuring 8.0 X 7.5 cm with a well-defined patent fistulous communication to the esophagus was resected. Microscopic examination revealed a saccular structure with a mucosal lining of pseudostratified columnar epithelium. Large bundles of smooth muscle were present in the fibrous wall of the mass. Hyaline cartilage was identified. as were nerves and blood vessels. The pathological diagnosis was mediastinal bronchogenic cyst.
REFERENCES 1. Bergstrom JF, Yost RV, Ford KT, et al: Unusual roentgen manifestations of bronchogenic cysts. Radiology 107:49-54. Apr 1973 2. Maier HC: Bronchiogenic cysts of the mediastinum. Ann Surg 127:476-502. Mar 1948 3. Moskal M, Kusmierski S: Torbiel oskrzelopochodna oproznlajaca sie do przelyku. Pol Przegl Chir 44:883-885, May 1972 [Pol] 4. Reed JC, Sobonya RE: Morphologic analysis of foregut cysts in the thorax. Am J RoentgenoI120:851-860. Apr 1974 5. Rogers LF, Osmer JC: Bronchogenic cyst. A review of 46 cases. Am J Roentgenol 91:273-283. Feb 1964
DISCUSSION Bronchogenic cysts are thin-walled cysts lined by respiratory
I
Figs. 1 and 2. Postero-anterior (1) and lateral chest radiographs (2) show a retrocardiac mediastinal mass containing air and fluid. Fig. 3. Spot film from the barium esophagram shows a fistulous communication (arrows) between the esophagus and the cystic mass.
1
From the Department of Radiology, Santa Clara Valley Medical Center, San Jose, Calif. Accepted for publication in August 1977.
28
sjh
