Bronkhogenny cyst – the malformation of small bronchial tubes representing the thin-walled band education filled with a mucous secret of bronchial glands. The Bronkhogenny cyst can be asymptomatic or be shown by signs of a compression of a trachea, bronchial tubes, a gullet (cough, short wind, cyanosis, breast pains, a dysphagy, etc.). In the diagnostic relation the polyposition X-ray analysis, a linear and computer tomography, a bronchography, a bronkhoskopiya, ultrasonography of a sredosteniye are most informative. Treatment of bronkhogenny cysts quick – a tsistektomiya, a segmentary resection of a lung, lobectomy.
Bronkhogenny cyst - the congenital cystous education having a genetic linkage with a bronchial tree and repeating its morphological structure. Among all tumors of lungs and a sredosteniye the specific weight of bronkhogenny cysts makes 2-13%. Statistically more often they come to light at men of young and middle age, however can clinically find themselves even in children (including newborns) and teenagers. In one cases bronkhogenny cysts develop absolutely asymptomatically, in others – get quickly progressing and complicated current demanding the emergency surgical reaction. The potential risk of emergence of complications causes need of early diagnosis of bronkhogenny cysts and their timely planned treatment.
As well as other malformations of lungs, a bronkhogenny cyst it is formed in connection with violation of an embryogenesis. It is considered that defect of division of primary gut into digestive and respiratory tubes is the cornerstone of this pathology. What factors promote emergence of this violation for certain it is not known. Cages of primary gut can get in the implantation way to rudiments of any bodies that causes localization of bronkhogenny cysts not only in a trachea and bronchial tubes, but also heart, a gullet, a pancreas, a diaphragm, etc.
In the majority the bronkhogenny cysts have the rounded or ovoidny shape, single-chamber structure; the average amount of educations makes 6-10 cm. The cyst wall thin (3-5 mm), its internal surface is presented by a vibrating cylindrical epithelium of bronchial tubes (more rare a flat or cubic epithelium). Quite often the cyst wall completely repeats a structure of a trakhealny or bronchial wall and contains friable connecting fabric, mucous glands, smooth muscles, a hyaline cartilage, vessels, nervous fibers and fatty tissue. In uncomplicated cases bronkhogenny cysts are filled mucous , transparent or slightly rather turbid liquid. At infection contents of a cyst gain purulent character.
In pulmonology bronkhogenny cysts can be classified depending on the size, localization, communication with a trakheobronkhialny tree and character of a current. The sizes of cysts vary from small (less than 5 cm in the diameter) to huge (to 20 and more than a cm), squeezing a pulmonary parenchyma and causing a share or the whole lung. According to location bronkhogenny cysts share on:
- trakheobronkhialny (paratrakhealny, bifurcation and radical)
- esophageal (paraezofagealny and intramuralny)
- intra pulmonary
- the bronkhogenny cysts having atypical localization (okolodiafragmalny, intra pleural, parapancreatic, etc.)
Mediastinalny cysts come to light in a zadneverkhny and peredneverkhny sredosteniye more often, is more rare in other its departments. Depending on existence of the message with a trachea and bronchial tubes allocate the closed (not drained) and open (drained) bronkhogenny cysts. The last them them, except mucous contents, also contain air. The course of cysts can be smooth, uncomplicated or complicated (a compression syndrome, infection, break in a pleural cavity or a bronchial tube).
Symptoms of bronkhogenny cysts
About 30% of educations develop asymptomatically and are found when passing preventive fluorography. At other patients various clinical manifestations caused by localization, the size of a cyst and existence of complications take place.
So, the closed trakheobronkhialny cysts can cause dry persuasive cough, and reported with a bronchial tube - cough with a mucous phlegm. The bronkhogenny cysts located in the field of bifurcation of a trachea give the brightest clinical picture. In this case, except the phenomena of a trakheobronkhit, signs of a sdavleniye of a trakheobronkhialny tree early develop: inspiratory short wind, cyanosis, thorax pains. Bronkhogenny cysts of esophageal localization at achievement of certain sizes cause a dysphagy. Pericardiac cysts quite often provoke persistent sinusovy tachycardia and premature ventricular contraction, changes to the ECG in the form of focal blockade of legs of a bunch of Gis.
At infection of a cyst high fever, the expressed symptoms of purulent intoxication develops. At break of purulent contents in bronchial tubes there is cough with a purulent phlegm, development of aspiration pneumonia is possible, and children have a threat of asphyxia. Suppuration, pulmonary bleeding, pheumothorax and hydropheumothorax, a sdavleniye of bodies of a sredosteniye (including a syndrome of the top hollow vein), lungs most often occurs among complications of bronkhogenny cysts. The malignization of a bronkhogenny cyst can be rare, but quite probable complication.
Because the clinical symptomatology can be absent, and fizikalny data are not specific, crucial importance in diagnosis of bronkhogenny cysts belongs to tool researches. By means of ultrasonography the sredosteniya becomes clear localization, a form, contours, the sizes, topografo-anatomic relationship of volume education and its origin is supposed.
At a polyposition X-ray analysis of a thorax in typical cases the spherical or oval homogeneous shadow of average intensity, decides on accurate contours. When imposing a shadow of a sredosteniye on a cyst shadow carrying out a pnevmomediastinografiya or X-ray analysis of a gullet with a baric suspension in addition is required. The bronkhoskopiya and a bronchography allows to establish anatomic relationship of a bronkhogenny cyst with a trakheobronkhialny tree. In the presence of signs of a sdavleniye of the top hollow vein or a chest lymphatic channel performance of a flebografiya and limfografiya is expedient.
Thin-walled bronkhogenny cysts are characterized by change of their configuration and situation at introduction of gas to a sredosteniye or a pleural cavity (unlike dermoidny cysts with a thick wall or dense tumors of a sredosteniye). Thorax MSKT in some cases allows to refuse performing invasive diagnosis of bronkhogenny cysts and in advance to plan the intervention volume as gives exhaustive information on localization and the amount of education.
The full complex of diagnostic actions provides exact differential diagnostics at a presurgical stage, allowing to reject terato-dermoidny formations, timoma, nevrinoma, tselomichesky cysts of a pericardium, etc. sredosteniye tumors.
Treatment of bronkhogenny cysts
Tactics of observation and conservative treatment of bronkhogenny cysts is inefficient and risky. Considering a high probability of emergence of serious complications (perforation, bleeding, suppuration, a sdavleniye of bodies of a sredosteniye, etc.), an optimum method is planned surgical intervention.
Conditionally conservative tactics can be applied at a stage of training of patients for surgical treatment. It can include dezintoksikatsionny and antibacterial therapy, a bronchoscopic kateterization or a chreskozhny puncture of a cyst with aspiration of pus and sanitation of a cavity at suppuration, drainage of a pleural cavity (at break of a cyst) etc.
The volume of an operational grant varies from a tsistektomiya to a segmentary resection of a lung or lobectomy. At the drained bronkhogenny cyst defect in a wall of a bronchial tube is taken in. The most often thoracic surgeons carry out a torakotomiya from perednebokovy or side access. In recent years even more often removal of bronkhogenny cysts is made by means of torakoskopichesky operation.
Forecast and prevention
The result of operations is in most cases favorable. Among postoperative complications bronchial fistulas, intra pleural bleedings, pneumonia, an empiyema of a pleura meet. As a rule, they arise at the patients operated concerning suppuration of a bronkhogenny cyst. Among children the lethality makes about 5%. Due to the low-study of an etiology of congenital educations it is recommended to avoid teratogenny influences during incubation of a fruit.