Thorac Cardiovasc Surg 2019; 67(S 02): S101-S128
DOI: 10.1055/s-0039-1679098
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Tuesday, February 19, 2019
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Georg Thieme Verlag KG Stuttgart · New York

Life-threatening Bronchogenic Cyst in a Pediatric Patient: Importance of Timely Diagnosis and Surgery

I. Hüners
1   Cardiac Surgery for Congenital Heart Disease, University Heart Center Hamburg, Hamburg, Germany
,
M. Böttcher
2   Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
S. Westhofen
1   Cardiac Surgery for Congenital Heart Disease, University Heart Center Hamburg, Hamburg, Germany
,
M. Köhne
1   Cardiac Surgery for Congenital Heart Disease, University Heart Center Hamburg, Hamburg, Germany
,
R. Kozlik-Feldmann
3   Department of Pediatric Cardiology, University Heart Center Hamburg, Hamburg, Germany
,
H. Reichenspurner
4   Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
,
A. Riso
1   Cardiac Surgery for Congenital Heart Disease, University Heart Center Hamburg, Hamburg, Germany
,
S. J. Sachweh
1   Cardiac Surgery for Congenital Heart Disease, University Heart Center Hamburg, Hamburg, Germany
,
K. Reinshagen
2   Department of Pediatric Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
,
D. Biermann
1   Cardiac Surgery for Congenital Heart Disease, University Heart Center Hamburg, Hamburg, Germany
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Publikationsverlauf

Publikationsdatum:
28. Januar 2019 (online)

Objectives: Bronchogenic cyst (BC) is rare and indication for early invasive treatment for BC is still under discussion. Nevertheless, life-threatening complications due to compression, infection, hemorrhage, and rupture are outlined in the literature.

Case: Here, we present the case of a 6-year-old boy who was admitted to our center with dry cough and exertional dyspnea. Bronchoscopy showed compression of the left main bronchus and X-ray demonstrated consecutive complete atelectasis of the left lung and advanced mediastinal shift. CT scan confirmed the massive finding and depicted a giant mass of 38 × 32 mm in the posterior mediastinum. Furthermore, echocardiography revealed moderate stenosis of left pulmonary artery. The findings indicated surgery in a timely fashion. The extirpation of the cyst through a minimally invasive lateral approach was not feasible due to hyperinflation of the right lung and decreased peripheral oxygenation with a high risk for ECMO necessity. Consequently, a median sternotomy was performed via a limited skin incision. The BC originated at the trachea and was excised in toto under technical challenging conditions caused by the mediastinal shift. Histopathology confirmed the diagnosis of a BC. The postoperative course was uneventful and the patient was discharged from hospital 11 days after surgery without symptoms and a nearly normal chest X-ray.

Conclusion: Treatment for BC strategies differs in invasiveness and in frequency of postoperative complications. Full median sternotomy should be reserved for the rare cases with a cyst in the posterior mediastinum or sophisticated advanced cases like ours. In this case, the patient had a short recovery time without wound infection or other complications.