Case Report: Multimodality imaging of a bronchogenic cyst in the interatrial septum

Abstract

Intracardiac bronchogenic cysts (IBCs) are very rare. To date, only a few cases of IBC have been reported in the literature. We report a case of a bronchogenic cyst that arose from the interatrial septum in a 42-year-old man who presented with symptoms of palpitation. A unilocular cystic lesion of the heart was found initially on echocardiography and subsequently on computed tomography and magnetic resonance imaging. The diagnosis was further confirmed by histopathology after surgical resection. Multimodality imaging played a crucial role in the diagnosis and treatment of such rare lesions.

Keywords: bronchogenic cyst; congenital anomaly; diagnosis; interatrial septum; therapy.

Figure 1

(A) The preoperative 12-lead ECG showed a third-degree atrioventricular block. (B) The postoperative ECG showed a first-degree atrioventricular block.

Figure 2

Echocardiography showing the well-defined ovoid interatrial lesion (arrow). (A) Transthoracic echocardiography showing a well-demarcated hypoechoic ovoid mass embedded in the interatrial septum in the apical four-chamber view; (B) TEE showing a homogeneous, isoechoic mass at the interatrial septum—the mass is well-defined and has a smooth surface; (C) the mass was not enhanced by the use of a contrast agent; and (D) three-dimensional TEE illustrating the relationship between the mass and surrounding structures.

Figure 3

(A) Contrast-enhanced CT shows a low-intensity ovoid nodule without obvious enhancement at the interatrial septum (arrow). The mean attenuation value was approximately 63 Hu. (B) Cardiac MRI shows a round mass in the interatrial septum measuring 30 mm × 20 mm (arrow). Neither fat deposition nor late gadolinium enhancement were identified in the tumor.

Figure 4

Histology shows the surface of the cystic lesion lined by pseudostratified ciliated columnar epithelium (arrow), smooth muscle cells within the fibrous tissue wall of the cyst, and acute inflammatory cells.