Left Ventricular Bronchogenic Cyst
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 2×3 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.
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.