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Clinical Problem Solving: Radiology
May 18, 2009

Radiology Quiz Case 2: Diagnosis

Author Affiliations
 

C. DOUGLASPHILLIPSMD

Arch Otolaryngol Head Neck Surg. 2009;135(5):516-519. doi:10.1001/archoto.2009.35-b

Bronchogenic (or bronchial) cysts are rare congenital anomalies that result from abnormal development of the tracheobronchial tree. At approximately the fourth week of gestation, the respiratory diverticulum forms as an outgrowth of the ventral foregut and then extends inferiorly to form the trachea, bronchi, and lungs. Abnormal budding of the tracheobronchial system can occur, giving rise to supernumerary bronchi if the outgrowth remains in continuity with the developing tree or bronchogenic cysts in cases in which this connection is obliterated. The majority of bronchogenic cysts occur in the anterior mediastinum (83% in one 22-year retrospective case review)1or within pulmonary parenchyma. However, extrathoracic bronchial cysts can form as the result of abnormal budding of the proximal trachea1,2or from superior migration of unattached buds, which are then pushed anteriorly by the mesenchymal bars that form the sternum.1Extrathoracic cysts most commonly occur in the suprasternal notch and manubrium but may also present in the neck, chin, shoulder, and scapular regions, as well as at the base of the tongue, and can extend into the mediastinum.3

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