Reach Us +44-1647-403003
Bronchogenic Cyst: An Uncommon Cause of Back Pain | OMICS International
ISSN: 2165-7920
Journal of Clinical Case Reports
Make the best use of Scientific Research and information from our 700+ peer reviewed, Open Access Journals that operates with the help of 50,000+ Editorial Board Members and esteemed reviewers and 1000+ Scientific associations in Medical, Clinical, Pharmaceutical, Engineering, Technology and Management Fields.
Meet Inspiring Speakers and Experts at our 3000+ Global Conferenceseries Events with over 600+ Conferences, 1200+ Symposiums and 1200+ Workshops on Medical, Pharma, Engineering, Science, Technology and Business
All submissions of the EM system will be redirected to Online Manuscript Submission System. Authors are requested to submit articles directly to Online Manuscript Submission System of respective journal.

Bronchogenic Cyst: An Uncommon Cause of Back Pain

Clarice Zhang*, Heather Hughes, Adam Schwartz and Steven Sattler

Good Samaritan Hospital Medical Center, USA

*Corresponding Author:
Clarice Zhang
Good Samaritan Hospital Medical Center, USA
Tel: +1 631-376-3000
E-mail: [email protected]

Received date: March 31, 2016; Accepted date: June 21, 2016; Published date: June 26, 2016

Citation: Zhang C, Hughes H, Schwartz A, Sattler S (2016) Bronchogenic Cyst:An Uncommon Cause of Back Pain. J Clin Case Rep 6:814. doi:10.4172/2165-7920.1000814

Copyright: © 2016 Zhang C, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Visit for more related articles at Journal of Clinical Case Reports


Bronchogenic cysts, although rare, are one of the most common primary mediastinal masses; symptomatic presentation
is infrequently seen in adults. Most adults with a bronchogenic cyst may go through life without knowing that
they have one. We present a case of a symptomatic bronchogenic cyst in an adult female. Typically, bronchogenic
cysts are located in the superior and medial aspects of the mediastinum; our patient presents with an extremely rare
presentation. The cyst was adherent to both the esophagus and pericardial surface.


Bronchogenic cyst; Back pain; Mediastinal cyst; Lung cyst; Thoracic cyst; Cenign cyst

Case Report

A 55-year-old previously healthy Caucasian female presented to the emergency department (ED) with four days of back pain. The pain began near the angle of her right scapula and radiated to both shoulders and across her posterior neck. The patient had a history of chronic generalized back pain but stated that this pain was different; it was more intense and sharper than usual. The pain was exacerbated by laying supine and was not relieved with either ibuprofen or warm compresses. She denied chest pain, shortness of breath, nausea, vomiting, fevers, cough, dysphagia and hoarseness of her voice. There was no history of trauma, recent infections, recent travel or unexpected weight change. She reported a history of thoracentesis over ten years ago, due to a right-sided pleural effusion of unknown origin. She was not on any medications and reported no allergies. Her social history and family history were not contributory.

Her initial vital signs were a blood pressure of 160/100 mmHg, heart rate of 58 beats per minute, respiratory rate of 24 breaths per minute with an oxygen saturation of 98% on room air and an oral temperature of 36.7°C. The patient was a well appearing woman who was not in any apparent distress. Her physical exam, including the neurological exam, was unremarkable. There was no localized tenderness to palpation overlying the areas of described discomfort or deformity of her spinal column.

Laboratory tests were obtained and were significant for a white blood cell count of 16,100/uL and a mildly elevated Troponin I of 0.079 ng/mL with a normal electrocardiography. It is unknown why her Troponin levels were elevated; however, her levels trended down over the course of the next several days. The rest of her laboratory results were all within normal range. Chest radiograph (CXR) was significant for an enlarged transverse diameter of the cardiac silhouette. Lung fields were clear and without effusions (Figure 1). A computed tomography (CT) scan with intravenous contrast was performed to further evaluate the abnormal finding on the CXR and was significant for a 9.1 cm cyst adjacent to the posterior aspect of the pericardium (Figure 2). Echocardiography showed an approximately 8 × 9 cm non-septated cystic appearing structure adjacent to the left atria, best seen in the apical 4-chamber view (Figure 3).


Figure 1: CXR PA view showing widened transverse diameter of cardiac silhouette.


Figure 2: CT angiography of chest with IV contrast showing posterior cyst in soft tissue window.


Figure 3: Posterior cyst visualized in apical 4-chamber view.

A video-assisted thoracoscopic surgery (VATs) found the cyst in the lower lobe of the right lung. It was adherent to both the esophagus and the pericardial surface without evidence of airway obstruction, esophageal compression or displacement of major mediastinal vessels. A total of approximately 800 mL of yellow cloudy fluid was drained. Histopathological examination confirmed it to be a benign bronchogenic cyst. There were no reported complications from the VATs and the patient was discharged home 6 days later in good condition.


Bronchogenic cysts are rare congenital abnormalities that account for 5-15% of all primary mediastinal masses [1-6]. They arise during the primitive foregut development between the 3rd and 6th weeks of gestation along the tracheobronchial tree usually within the carina [2-8]. Histologically, bronchogenic cysts are lined by cells similar to respiratory tract epithelium and can contain mucoid material of variable viscosity and color [7-9]. Typically they are located on the superior and medial aspects of the mediastinum. Rarely, they have also been found in the intra-parenchymal, subcutaneous, intra-abdominal, pelvic and retroperitoneal regions [3,10-12].

Symptoms vary with age and are largely dependent upon size and location [13]. There appears to be a bimodal age peak for symptom-atic presentation. Most commonly they are symptomatic in children younger than 6 and adults aged 40-60, with a male predominance [6,8,14]. As many as two-thirds of children develop symptoms due to compression of respiratory structures.5 Bronchogenic cysts in this population are potentially more life threatening due to the smaller thoracic cavity and softer more narrow airway of children when compared to adults. Patients may present with stridor and recurrent pulmonary infections. Severe compression has even been noted to cause death in neonates and infants [15].

In adults, despite the potential to grow to relatively large sizes, most are asymptomatic and are often discovered incidentally [4,5]. Symptomatic patients often have larger sized masses ranging from 7-13 cm. Patients typically present with chest pain, dyspnea, cough, fever, and vocal hoarseness. Complications include recurrent respiratory obstruction, fistulae formation and cyst cavity haemorrhage [4,7,9,13,16,17].

Although rare, fistulae formation is important to consider in a patient with recurrent and chronic pulmonary sepsis; in a small percentage of patients, these fistulas allow bacterial propagation into the respiratory tract [1,7,13,15,16]. Other less commonly reported complications include superior vena cava syndrome, arrhythmias, pulmonary artery obstruction, pneumothorax, hemoptysis, esophageal compression and cyst rupture [1,8,13,15]. A few case reports have noted associated metaplasia and malignant transformation of these cysts; however, this remains controversial and requires further studies [2,8].

For symptomatic patients, VATs to enucleate and devitalize the cyst wall is definitive treatment [5]. In asymptomatic individuals diagnosed incidentally, surgical intervention is recommended to prevent future complications, as described above [4,6,14,18]. Post-operative prognosis is exceptional [6,15].

This was a unique case of a symptomatic bronchogenic cyst in a middle-aged female presenting with back pain. Seventy-five percent of patients with bronchogenic cysts are asymptomatic [13]. Many are diagnosed incidentally during exploration of other diseases. In cases where patients present with a symptomatic cyst, back pain is not considered one of the most common presentations. Approximately 2.4% of all ED visits per year are for the chief complaint of back pain [19]. Over 90-95% of patients presenting with back pain have non-life threatening diagnoses [19]. Differential diagnosis that we typically consider are musculoskeletal strain or spasm, vertebral dysfunction, disc disease, thoracic aneurysms or dissections, spinal metastasis and spinal epidural abscess or hematoma. Bronchogenic and mediastinal cysts should perhaps be considered more frequently. Despite her history of chronic back pain, our patient presented with symptoms atypical of her usual pain, which we suspect may have been caused by expansion of the cyst. Theoretically this is caused by stretching of nerves in the parietal pleura by an enlarging cyst [13]. To date, there have only been a few reported cases of back pain associated with the occurrence of a bronchogenic cyst [3]. In our patient, removal of the inciting agent lead to complete resolution of her symptoms after a six-month follow-up.

In most adult patients, bronchogenic cysts are not acutely life threatening; however, they have the potential to lead to long-term morbidity and mortality if they are left undiagnosed. Although rare, mediastinal cysts such as ones of bronchogenic origin should be considered in the differential diagnosis of patients presenting with undifferentiated back pain.


Select your language of interest to view the total content in your interested language
Post your comment

Share This Article

Relevant Topics

Article Usage

  • Total views: 10216
  • [From(publication date):
    June-2016 - Sep 22, 2019]
  • Breakdown by view type
  • HTML page views : 10122
  • PDF downloads : 94