PRESENTATION AND MANAGEMENT OF BRONCHOGENIC CYSTS IN THE ADULT

Bronchogenic cysts are congenital anomalies of the bronchial tree that are often asymptomatic at presentation in adults. Management of asymp tomatic bronchogenic cyst in this population remains controversial. Ei ghteen patients with bronchogenic cysts were treated at our institutio n since 1975. At initial presentation, 10 patients (56 percent) were a symptomatic and 8 (44 percent) were symptomatic. Cough and pain were t he most frequent symptoms. Two patients presented with potentially ser ious complications, one with respiratory distress from airway compress ion and the other with infection and airway fistulae. Chest radiograph s were abnormal but nondiagnostic in 17 out of 18 (94 percent) patient s. Chest computerized tomography (CT) scans were abnormal in eight of eight (100 percent) patients, but they confirmed the benign cystic nat ure in only five of eight (62.5 percent). Overall, considering the use of all imaging modalities and clinical suspicion, bronchogenic cyst w as considered in the preoperative differential diagnosis in only 11 of 18 (61 percent) patients. Fifteen of 18 cysts were resected initially . Three of the asymptomatic patients who were followed up initially ul timately required resection because of the development of symptoms. A trend toward increased postoperative complications was noted in patien ts who were symptomatic at the time of surgery (27 percent vs 14 perce nt). In conclusion, adult patients with asymptomatic bronchogenic cyst may develop symptoms over time. Symptoms in adults can sometimes be p otentially serious. Since a confident preoperative diagnosis is not al ways possible and because surgical complications may be more common in the symptomatic patient, we recommend surgical resection of all suspe cted bronchogenic cysts in operable candidates.