Circulation. 2002;106:e209-e210
doi: 10.1161/01.CIR.0000046083.69395.A5
(Circulation. 2002;106:e209.)
© 2002 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Bronchogenic Cyst
Acute Presentation
R.F.J. Browne, MD, FFRRCSI;
S. Fitzgerald, MD, MRCPI;
V. Young, MD, FRCS, (C.Th.), FRCSI;
B. Hogan, MD, FRCR;
D. Moore, MD, FRCPI
Department of Radiology (R.F.J.B., B.H.), Cardiology (S.F., D.M.), The Adelaide and Meath Hospital, Tallaght, and Department of Cardiothoracic Surgery (V.Y.), St James’s Hospital, Dublin, Ireland.
Correspondence to Dr R.F.J. Browne, Department of Radiology, The Adelaide and Meath Hospital, Tallaght, Dublin 24, Ireland. E-mail ronanbrowne{at}hotmail.com
A 41-year-old man presented with acute retrosternal pain radiating to the back. The suspected diagnosis was dissecting thoracic aortic aneurysm. Chest radiograph was normal. Computed tomography showed a well-defined subcarinal loculated mass of low density compressing the superior vena cava and ascending aorta anteriorly and the esophagus posteriorly (Figure 1). Transthoracic and transesophageal echocardiography revealed a 7-cm posterior cystic mass almost completely obliterating the left atrium and associated with a small pericardial effusion (Figure 2 and Figure 3). Complete surgical resection of the mass was performed without complication. Histological examination of resected tissue revealed ciliated stratified epithelium characteristic of a bronchogenic cyst (Figure 4). The patient remains asymptomatic 18 months after surgery.
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Figure 1. A, Contrast enhanced computed tomographic (CT) scan of the thorax showing a well-defined 7-cm subcarinal mass (curved arrow) of predominantly fluid attenuation with wall enhancement. The superior vena cava (short arrow) and ascending aorta (long arrow) are compressed anteriorly by the mass, and the esophagus is compressed posteriorly. B, The loculated nature of the mass is demonstrated on a higher image (arrow).
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Figure 2. Parasternal long axis transthoracic echocardiogram showing an echodense mass (arrow) apparently within the posterior left atrium (LA). There is a small posterior pericardial effusion. LV indicates left ventricle; AO, aorta.
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Figure 4. Fibrotic cyst wall lined by partially stratified epithelium with some cilia in keeping with a bronchogenic cyst.
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Figure 3. Midesophageal long axis transesophageal echocardiogram (TOE) image showing the large thick-walled echodense mass (arrow) posterior to the aortic root and proximal ascending aorta (AO).
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Footnotes
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.
