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

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.