Bronchogenic Cysts

What are bronchogenic cysts?

Bronchogenic cysts are a type of mediastinal tumor. They develop in the mediastinum. This is the space within your chest that holds certain blood vessels and organs like your esophagus and trachea. It also separates your lungs. Bronchogenic cysts are congenital, meaning you’re born with them.

You can have a bronchogenic cyst without having symptoms. Healthcare providers may detect a cyst during routine imaging tests. Most people are in their 30s or 40s when a cyst grows large enough to cause symptoms. Learning you’re living with a cyst in your chest may come as an unwelcome surprise. If tests show you or your child has one, your healthcare provider may recommend surgery to remove it.

What are the symptoms of bronchogenic cysts?

Bronchogenic cyst symptoms may include:

• Cough
• Dysphagia (difficulty swallowing)
• Fever
• Hoarseness
• Tachypnea (quick shallow breathing)
• Wheezing

You can have bronchogenic cyst symptoms at any age. But you may not have symptoms unless the cyst puts pressure on your trachea or esophagus. Bronchogenic cysts may be 2 to 15 centimeters (1 to 5 inches) in diameter. You may also develop symptoms from an infected cyst.

What causes bronchogenic cysts?

Bronchogenic cysts form during fetal development. Experts don’t know why the cysts form.

What are the complications of bronchogenic cysts?

Bronchogenic cysts can affect your ability to breathe or swallow and can become infected. But the most serious complication is if a cyst becomes cancerous.

How do healthcare providers diagnose bronchogenic cysts?

Bronchogenic cysts often show up during routine imaging tests. For example, a prenatal ultrasound may detect a bronchogenic cyst. The cyst may show up if you or your child has chest X-rays as part of a routine examination.

What happens if an imaging test detects a bronchogenic cyst?

That depends on the situation. For example, a prenatal ultrasound may show the fetus has a bronchogenic cyst. In that case, your obstetrician will monitor the cyst throughout fetal development. If tests show you or your child has cysts, a healthcare provider may order the following tests:

• Computed tomography (CT) scan: This test uses X-rays and a computer to make detailed images of the inside of your or your child’s mediastinum.
• Esophagram: This imaging test combines a series of X-rays after swallowing a contrast fluid to provide a detailed look at your esophagus or your child’s esophagus.
• Magnetic resonance imaging (MRI): MRIs produce more detailed images of your or your child’s mediastinum.

How is a bronchogenic cyst treated?

Your healthcare provider may recommend surgery to remove a bronchogenic cyst. Removing the cyst reduces the risk of complications. But their recommendations will be different depending on the situation.

Treatment during pregnancy

Your obstetrician will monitor the cyst. If it’s very large, they may do a procedure in utero (before birth) to drain fluid from it. Draining fluid can help reduce the risk that the cyst will press on the fetus’ heart.

Sometimes, bronchogenic cysts grow large enough to block a fetus’s airway. This doesn’t happen often. If it does, your obstetrician may recommend you have an EXIT procedure instead of a vaginal delivery or C-section. EXIT stands for ex-utero intrapartum treatment. You receive anesthesia before the surgery.

In this procedure, a surgeon makes a cut in your uterus to lift the fetus’s head, neck and torso through the incision. While the fetus still receives oxygen through your umbilical cord, the surgeon will make an incision (cut) to remove the cyst. After removing the cyst, they’ll cut the umbilical cord, and your obstetrician will deliver your baby through the same cut.

Treatment for newborns

Your newborn baby may not need treatment. Instead, their pediatrician will watch for symptoms that may mean your baby has a bronchogenic cyst. They’ll check on your baby’s overall health during well-baby care visits.

Treatment for infants, children and adults

A healthcare provider may recommend surgery like:

• Thoracotomy: During this procedure, your surgeon makes an incision (cut) in your side, back or between your ribs so they can remove the cyst.
• Video-assisted thoracic surgery (VATS): Your surgeon uses a thoracoscope (a fiber-optic camera) to locate the cyst so they can remove it without making an incision.

Complications of treatment

Surgery to remove a bronchogenic cyst may cause the following complications:

• Abnormal heart rhythms (arrhythmia). Adults may experience this complication.
• Blood clots and strokes. These issues affect adults more frequently than infants and children.
• Bruising.
• Collapsed lung (pneumothorax) or atelectasis (lung air sacs don’t properly inflate).
• Damage to nearby glands, organs, nerves or blood vessels.
• Hemorrhage including internal bleeding.
• Hypoxemia (low blood oxygen).
• Post-thoracotomy pain syndrome. This is pain that persists months after the surgery.
• Respiratory problems like pneumonia.
• Surgical site infection.

Complications may be different depending on the type of surgery you have. Your surgeon will discuss potential complications before your surgery.

Can bronchogenic cysts be prevented?

No, there’s no way to prevent them. Bronchogenic cysts happen during fetal development.

What can I expect if I have a bronchogenic cyst?

Your healthcare provider will order periodic imaging tests to check on the cyst. If a cyst grows large enough to affect your or your child’s health, a provider will recommend surgery to remove it.

When should I see my healthcare provider?

You should contact a healthcare provider if you or your child develops symptoms like:

• Hoarseness that doesn’t go away
• Difficulty swallowing
• Trouble breathing

A provider will order tests to see if a bronchogenic cyst is causing symptoms.