043. A 28-year-old woman with hemoptysis

Objective: To describe a rare case of bronchogenic cyst of the lung.

Case report: Α 28-year-old female presented with hemoptysis over the past few hours and left-sided chest pain for the past four days. Past medical history was notable for treated compulsive disorder, peptic ulcer [2000] and ovarian and mammary cysts under observation. She was a smoker with nine p-y history. The chest X-ray (CXR) showed a large fluid level over the left hemidiaphragm. A year ago CXR was normal. Chest computed tomography revealed an abscess with fluid level supradiaphragmatically at the left lower lobe (LLL), with bronchiectases and peribronchiectatic lesions in the same lobe. During bronchoscopy there was hemorrhage from B9 with signs of pressure from outside, without endobronchial lesions. Cytology of bronchial fluid was negative for malignancy and antibodies for echinococcus were also negative. During hospitalization the patient was afebrile and without respiratory insufficiency. Because of continuing hemoptysis and worsening chest pain she was referred for surgery. A stemmed mediastinal cyst arising from the diaphragmatic surface of the LLL was found and it was excised with sparing of the lung parenchyma. Pathology was consistent was bronchogenic cyst. A month later the patient has a normal CXR and is symptom-free.

Discussion: Bronchogenic cysts are rare congenital cystic malformations arising from the embryonic foregut and are located in the mediastinum or the lungs as fluid-filled formations that do not communicate with the tracheobronchial tree except if they are infected (when they enlarge suddenly due to a valve mechanism). They usually present with chest pain. Hemoptysis is rare and is thought to be due to pressure effects. Diagnosis is possible by determining the density of the cyst content (by computed tomography or magnetic resonance imaging). Stalks that connect the cyst to various intrathoracic structures have been described in up to 46% of cases. In our case, due to the fluid level, an abscess was included in the differential diagnosis. Treatment involves observation, fine needle aspiration of the contents and surgical excision. Due to the low complication rate the latter is recommended more often, before cyst complications, such as in our case, develop.

Keywords: Bronchoscopy; spirometry; hemoptysis