Zusammenfassung
ZIELSETZUNG: Bronchogene Zysten sind kongenitale Malformationen und werden häufig als Zufallsentdeckung bei asymptomatischen Patienten gefunden. Ein Wachstum dieser Zysten kann eine Kompression der Atemwegen und Blutgefäße verursachen, was zu klinischen Symptomen und möglichen Komplikationen führen kann. In der Computertomographie (CT) erscheinen bronchogene Zysten oft wie solide Tumore. Wir beschreiben in dieser retrospektiven Arbeit das diagnostische und therapeutische Management für Patienten mit bronchogenen Zysten. METHODEN: 11 erwachsene Patienten mit bronchogener Zyste wurden in eine retrospektive Fallstudie inkludiert. Die Mindestbeobachtungsdauer nach Diagnosestellung war 2 Jahre. Es wurde das Computertomogramm der Patienten erneut beurteilt und die Lokalisation, die Größe, die Hounsfield Einheiten (HU) und das Aussehen (zystisch ≤ 20 HU oder solide ≥ 20 HU) der Läsionen festgehalten. ERGEBNISSE: Acht der 11 in der CT gefunden Läsionen wurden als solider Tumor entsprechend den Hounsfield Einheiten interpretiert. Neun von den 11 Patienten wurden chirurgisch reseziert. Zwei asymptomatische Patienten wurden nicht operiert und sind im 2 jährigen Beobachtungszeitraum asymptomatisch ohne Wachstum der Zyste geblieben. Komplikationen der Resektion waren: 1 postoperative Blutung, 1 mehrmaliger Pneumothorax und ein Rezidiv der Zyste. Die Mortalität lag bei null. SCHLUSSFOLGERUNG: Bronchogene Zysten werden häufig fälschlich in der CT als solider Tumor diagnostiziert. Wenn die CT inkonklusiv ist, kann mittels MRI oder Ultraschall (EUS) die Differentialdiagnose getroffen werden.
Summary
BACKGROUND: Bronchogenic cysts are congenital malformations and are often detected in asymptomatic patients as an incidental finding. Growth can cause compression of airways and vessels, resulting in clinical symptoms and possible complications. On computed tomography (CT) scans, bronchogenic cysts frequently have the appearance of a solid tumor. We describe diagnostic strategy and management for patients with bronchogenic cysts. METHODS: Retrospective case study of 11 adults diagnosed with a bronchogenic cyst. The CT scan of all patients was revised and localization, size, Hounsfield Units (HU), and appearance (cystic or solid) of the lesions were reported. Lesions were arbitrarily considered cystic or solid when the radiographic density was below or above 20 HU, respectively. RESULTS: Eleven adults with a bronchogenic cyst were followed for at least 2 years after diagnosis. Eight of 11 detected lesions were judged as a solid lesion, based on the radiographic density (in HU) on CT images. Nine of 11 patients were treated by surgical resection. Two asymptomatic patients were not operated and remained asymptomatic without enlargement of the cysts during 2 years follow-up. Complications of resection were post-operative bleeding (n = 1), recurrent pneumothorax (n = 1), and recurrence of the cyst (n = 1). No mortality was observed. CONCLUSION: Bronchogenic cysts are frequently mistaken for a solid mass on CT scans. Further differentiation can be made by MRI or EUS when CT is inconclusive.
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Vos, C., Hartemink, K., Golding, R. et al. Bronchogenic cysts in adults: frequently mistaken for a solid mass on computed tomography. Wien Klin Wochenschr 123, 179–182 (2011). https://doi.org/10.1007/s00508-011-1541-3
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DOI: https://doi.org/10.1007/s00508-011-1541-3