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(Circulation. 2007;116:e385-e387.)
© 2007 American Heart Association, Inc.

Images in Cardiovascular Medicine

Left Ventricular Bronchogenic Cyst

Oliver Klass, MD; Martin H.K. Hoffmann, MD, PhD; Bernd Ludwig, MD; Frank Leithäuser, MD; Andreas Hannekum, MD, PhD

From the Department of Diagnostic and Interventional Radiology (O.K., M.H.K.H.), Institute of Pathology (F.L.), and Department of Cardiac Surgery (A.H.), University Hospital of Ulm, Department of Cardiology, Heart Center Ulm (B.L.), Ulm, Germany.

Correspondence to Dr Oliver Klass, Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Steinhövelstr 9, 89075 Ulm, Germany. E-mail oliver.klass{at}uniklinik-ulm.de

In a 42-year-old woman presenting with intermittent atypical angina, transthoracic echocardiography revealed a tumor of the left posterolateral ventricular wall (Movie I in the online-only Data Supplement and Figure 1). The patient was referred for cardiovascular magnetic resonance imaging. Left ventricular ejection fraction was calculated at 72%. Cardiovascular magnetic resonance revealed an irregular, intramyocardial cystic lesion that measured 2x3 cm. The lesion did not show any contrast enhancement and was located in the posterolateral wall of the left ventricle between the 2 papillary muscles of the mitral valve (movie file 2 and Figure 2). The diagnostic workup was completed by a computed tomography coronary angiography, which confirmed an intramyocardial, irregular lesion underlying the obtuse marginal branch of the circumflex artery (Figure 3a and 3b). The imaging findings of a cystic tumor with blunt indentations into adjacent myocardial structures and the clinical presentation culminated in a consensus to surgically excise the tumor. The lesion was successfully resected under support of extracorporeal circulation. Surgery exposed a lesion with a very thin-walled subendocardial layer and a mucous core (Figure 4). It could be excised in toto. Postoperative histology revealed the very rare case of an intramyocardial bronchogenic cyst.^1–4 Microscopically, the tumor consisted of a thin-walled cyst attached to the resected myocardium. The inner cavity was lined by ciliated respiratory epithelium, which is the characteristic feature of a bronchogenic cyst (Figure 5). The patient recovered very well from surgery and was discharged a few days later.

View larger version (77K): [in this window] [in a new window]   Figure 1. Echocardiography revealing a tumor in the left posterolateral ventricular wall on a long-axis 4-chamber view.

View larger version (94K): [in this window] [in a new window]   Figure 2. Cardiovascular magnetic resonance short-axis view shows an irregular, intramyocardial cyst (C) located between the 2 papillary muscles of the left ventricular (LV) wall.

View larger version (71K): [in this window] [in a new window]   Figure 3. Images generated with multidetector-row computed tomography. Short-axis (a) and long-axis (b) views display the relation of the circumflex artery (CA) to the intramyocardial cyst (C). LV indicates left ventricle.

View larger version (89K): [in this window] [in a new window]   Figure 4. Intraoperative exposure of the cystic mass. After cardiac arrest, an epicardial incision is placed above the location of the cystic mass.

View larger version (143K): [in this window] [in a new window]   Figure 5. Hematoxylin and eosin–stained photomicrograph showing the cyst adjacent to the myocardium (MC) and lined by ciliated respiratory epithelium (RE). Inset was obtained at a higher magnification of the area marked with a rectangle.

	Disclosures

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None.

	Footnotes

 
The online-only Data Supplement, consisting of movies, can be found with this article at http://circ.ahajournals.org/cgi/content/full/116/16/e385/DC1.

	References

Top Disclosures References

 
1. Ahn SG, Tahk SJ, Shin JH. Images in cardiology: abnormal left atrial membranous structure in transthoracic echocardiography caused by external compression from a large bronchogenic cyst. Heart. 2006; 92: 200.[Free Full Text]

2. Prates PR, Lovato L, Homsi-Neto A, Barra M, Sant’Anna JR, Kalil RA, Nesralla IA. Right ventricular bronchogenic cyst. Tex Heart Inst J. 2003; 30: 71–73.[Medline] [Order article via Infotrieve]

3. Wei X, Omo A, Pan T, Li J, Liu L, Hu M. Left ventricular bronchogenic cyst. Ann Thorac Surg. 2006; 81: e13–e15.[Abstract/Free Full Text]

4. Weinrich M, Lausberg HF, Pahl S, Schafers HJ. A bronchogenic cyst of the right ventricular endocardium. Ann Thorac Surg. 2005; 79: e13–e14.[Abstract/Free Full Text]

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Klass, O. Articles by Hannekum, A. Search for Related Content PubMed PubMed Citation Articles by Klass, O. Articles by Hannekum, A. Related Collections Congestive Acute coronary syndromes CT and MRI Echocardiography CV surgery: other Pediatric and congenital heart disease, including cardiovascular surgery Related Article