Minimally invasive, multi-disciplinary approach for surgical management of a mediastinal congenital bronchogenic cyst in a 6-month-old infant

Abstract

We present a case of prenatal diagnosis of a mediastinal cyst by ultrasound, confirmed during infancy through computed tomography (CT) and magnetic resonance imaging (MRI). A 6-month-old male infant was admitted to the hospital. A mid-mediastinal cyst was detected through a province-wide fetal ultrasonography screening program. During the infancy stage, the CT scan and the MRI confirmed the finding of a mediastinal cyst. Based on the findings on prenatal ultrasonography and postnatal imaging studies (CT, MRI), a benign mediastinal cyst was suspected. The cyst was below the tracheal carina, and the patient developed symptoms of respiratory distress. Owing to the enlargement trend of the cyst, the respiratory distress it has caused, and the anxiety it caused to the patient's family, a multi-disciplinary conference reached the consensus that surgical resection is the treatment of choice and a carina-approach mediastinal lesion resection via video-assisted thoracoscopic surgery (VATS) was performed. The cyst was removed successfully. Although this report is of a single case and follow-up duration is not long enough, we nevertheless make the first move to improve the pattern to a feasible, reliable, and efficient one, which could be used to treat similar patients.

Keywords: Case reports; bronchogenic cyst; mediastinal cyst.

Figure 1

Preoperative cardiac computed tomography scans. (A) Transverse plane; (B) coronal plane; (C) sagittal plane. *, the cyst.

Figure 2

Four key steps of the surgical procedure. (A) The location is punctured; (B) the cyst is exposed for drainage; (C) clamps are used for dissection; (D) complete resection and thoracic washing are performed.

Figure 3

The minimally invasive surgery was successfully performed by cardiac surgeons and thoracic surgeons. (A) Surgical incision; (B) 5-mm high-definition 30° thoracoscope; (C) the specimen (3 cm × 2 cm).

Figure 4

Postoperative cardiac computed tomography scans showing absence of the mass. (A) Transverse plane; (B) coronal plane; (C) sagittal plane.

Figure 5

Pathological findings based on the paraffin-embedded tumor tissues by immunohistochemistry confirm a bronchogenic cyst. (A) The cyst wall is composed of smooth muscle, cartilage, and adipose tissue (magnification: 4×10); (B) the histiocytic cells and secretions are seen in the alveolar spaces (magnification: 20×10).