Compressive Bronchogenic Cyst: A Case Report From The Festoc Center In Bamako

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Introduction: Bronchogenic cysts are congenital malformations of the homoplastic dysembryoma type, producing cavities lined with bronchial epithelium and containing air and/or mucoid material. Their location may be mediastinal (30-40% of cases) or intrapulmonary (60-70% of cases) [1]. Infection is one of the most frequent complications of these cysts. Infection may be secondary to common germs, and association with pulmonary tuberculosis is exceptional. Observation: This 49-year-old patient was admitted to our department with an 08-month history of paroxysmal cough, mild dyspnoea on exertion and chest pain. Cardiovascular risk factors included smoking (45 pack-years), which had been weaned for 1 year. The physical examination on admission was unremarkable. Tuberculosis workup, including sputum Genexpert and tuberculin intradermal reaction, was normal. Chest X-ray revealed a well-limited, round, homogeneous hydric opacity measuring 5cm long on the left paracardiac axis. Cardiac ultrasound revealed a left retroventricular mass partially limiting ventricular contractions. A thoracic CT scan revealed a well-limited proximal liquid mass with poly-lobed contours, hypodense and non-enhanced after intravenous injection of contrast medium. The mass was biopsied and removed by left posterolateral thoracotomy. Postoperative management was straightforward. Anatomopathological study of the surgical specimen revealed a cystic formation lined by a respiratory-type lining in the process of necrosis. This was fibrosis with foci of cartilage and lymphoid tissue. Overall, the histological appearance was consistent with a brochogenic cyst. Conclusion: Bronchogenic cysts are rare congenital malformations, which can remain asymptomatic for a long time. The main complications are compression of mediastinal organs, superinfection, intracystic haemorrhage or, exceptionally, malignant degeneration. Surgery remains the best therapeutic option.

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