Triplegic Stroke After Air Embolism From Bronchogenic Cyst Secondary to Barotrauma.

Emergency medical assistance is rare regarding air travel. Pulmonary barotrauma during air travel can occur in asymptomatic patients who have underlying intraparenchymal pulmonary pathology such as bullae or bronchogenic cysts. During aircraft travel the resultant decrease in pressure during the ascent can lead to expansion of cyst volume, culminating in tears and leakage of air into the surrounding vasculature and thus the potential for air embolism. We describe a case of massive cerebral air embolism secondary to pulmonary barotrauma in a previously asymptomatic patient.

A giant intradiaphragmatic bronchogenic cyst: case report and literature review.

Bronchogenic cysts are congenital lesions developing during early embryogenesis. The intradiaphragmatic location is extremely rare. We present a giant bronchogenic cyst arising from the left crus of diaphragm. Based on our literature review results, intradiaphragmatic bronchogenic cysts have the following characteristics: 1) they are more common in female patients; 2) the patients are usually asymptomatic, or present with symptoms of chest pain, abdominal pain, and hiccups; 3) the cysts located in the left diaphragm are more than those in the right diaphragm, most of which are located in the area of the left diaphragm crus.

Congenital cystic lesions of the lung.

Congenital cystic lesions of the lung are present in 1 in 10,000-35,000 births and present as a spectrum of anomalies. Majority of these cystic lesions comprise congenital cystic adenomatoid malformations, pulmonary sequestrations, congenital lobar emphysema, and bronchogenic cysts. Most of these lesions are nowadays detected antenatally, however some will present either in the newborn or during later childhood. A review of the aetiology, classification, natural history, investigations, and treatment of congenital cystic lung lesions is discussed.

Congenital bronchial atresia with partial anomalous pulmonary venous return.

A 35-year-old woman with a high fever had a cystic lesion of the right lung including fluid and air. She was diagnosed with an infected bronchial cyst caused by congenital bronchial atresia with partial anomalous pulmonary venous return. She underwent a right upper lobectomy successfully. Patients with congenital bronchial atresia often have recurrent pulmonary infections with various imaging findings. The aberrant vein may relate to interruption of the bronchus in a patient with partial anomalous pulmonary venous return. Although segmental resection is recommended for this benign disease, lobar resection may be unavoidable because of adhesions or destruction of adjacent segments.

Microsurgical management of bronchogenic cysts in the thalamus: an illustrative case and literature review.

Intracranial bronchogenic cysts are extremely rare. This is the first reported case of a bronchogenic cyst arising from the thalamus. Complete microsurgical resection was undertaken. A literature review was conducted to explore the etiologies, diagnostic approaches, and therapeutic strategies for this type of rare disease.

Surgical management of mediastinal lesions.

Mediastinal tumors and cysts are relatively uncommon lesions requiring histologic confirmation. This retrospective study reports the experience of our department in the diagnosis and treatment of mediastinal lesions. Mediastinal lesions that were surgically treated in 200 patients aged 6-84 years, during a period of 28 years, were included in this series. Sixty patients had an apparently non-resectable lesion or lymphadenopathy of the anterior superior mediastinum. They had an anterior mediastinotomy and biopsy of the mediastinal lesion. No perioperative deaths were recorded in those patients. There were recorded 5 (8.3%) complications. Histological diagnosis was established in all patients: lymphoma (n = 21), metastatic carcinoma (n = 16), thymic lesions (n = 10), germ cell tumor (n = 3), other lesions (n = 10). The remainder 140 patients underwent a resection of the mediastinal lesion. One (0.7%) perioperative death and 21 (15%) complications were recorded. The histological diagnosis of the excised lesions was: thymic lesions (n = 60), neural tumors (n = 21), thyroid lesions (n = 14), bronchial cysts (n = 12), pericardial cysts (n = 10), germ cell tumors (n = 6), other lesions (n = 17). Our results are compared favorably with those reported in international literature. Surgery is the management of choice for patients with mediastinal lesions. It allows for establishing certain histological diagnosis and curative excision of the lesion, when it is necessary, with low operative risk.

A bronchogenic cyst of the right ventricular endocardium.

In a 73-year-old male patient with a history of prostate cancer, a right ventricular endoluminal tumor was diagnosed by echocardiography. An endocardial papillary fibroelastoma or myxoma appeared possible; a malignant tumor could not be ruled out. The tumor was resected using extracorporeal circulation and cardioplegic arrest. Histopathology study revealed a bronchogenic cyst with ciliated epithelium.

Quiste pulmonar congénito gigante asociado a hipoplasia pulmonar: Presentación de un caso y revisión de la literatura / Congenital giant lung cyst associated with pulmonary hypoplasia: A case report and literature review

Los quistes congénitos del pulmón son un grupo diverso de anomalías que pueden ser únicos o múltiples y variar grandemente en su volumen. Por lo regular están confinados a un segmento o lóbulo y son asiento frecuente de infección. Se presenta el caso de un quiste broncogénico intrapulmonar gigante acompañado de hipoplasia de la arteria pulmonar izquierda y del lóbulo pulmonar superior ipsilateral. Se hacen consideraciones relacionadas con el origen del quiste, su relación con la hipoplasia arterial y pulmonar y se discuten las posibles causas de la atelectasia y edema posoperatorios, que llevaron a la necesidad de completar la neumonectomía ante un cuadro séptico severo(AU)

The congenital lung cysts are a group of diverse abnormalities, unique or multiple, and of different volumes. Generally, they are confined to a segment or lobe and they are a frequent site of infection. The case of a bronchogenic intrapulmonary giant cyst accompanied with hypoplasia of the left pulmonary artery and of the upper ipsilateral pulmonary lobe, is reported. Considerations are made on the origin of the cyst, and on its connection with arterial and pulmonary hypoplasia. The possible causes of postoperative atelactasis and edema, leading to the need of completing pneumonectomy in the face of a severe septic picture, are discussed(AU)

The anesthetic management of an intrabronchial escape of a hydatid's ruptured laminated membrane during rigid bronchoscopy.

We describe the anesthetic management of a case in whom a previously undiagnosed pulmonary hydatid cyst manifested as a large amount of intrabronchial fragmented pieces of laminated membrane suddenly and unexpectedly during diagnostic rigid bronchoscopy.

Cisto broncogênico complicado por mediastinite e empiema contra-lateral / Bronchogenic cyst complicated by mediastinitis and contralateral empyema

O cisto broncogênico, apesar da aparência pouco ominosa como opacidade de contornos precisos no mediastino, tem potencial não desprezível para complicar. Relatamos um caso de complicação grave em um paciente de 28 anos com queixa de dor epigástrica irradiada para o dorso, e radiografia de tórax demonstrando massa bem delimitada no mediastino posterior e inferior à direita. Em cinco dias evoluiu para sepse decorrente de mediastinite e empiema pleural à esquerda. O paciente necessitou ser submetido a toracotomia esquerda para descorticação pulmonar precoce e desbridamento do mediastino e, num segundo tempo com intervalo de uma semana, a toracotomia direita para ressecção do cisto mediastinal infectado. Este caso enfatiza a indicação sensata de ressecção dos cistos mediastinais mesmo na apresentação assintomática, face ao risco inerente de complicações.

Multiple pulmonary leiomyomatous hamartomas associated with a bronchogenic cyst in a man.

Multiple pulmonary leiomyomatous hamartomas (MPLHs) are extremely rare lesions. We present a case of MPLHs associated with a bronchogenic cyst in a symptomless, 46-year-old man. Previously, MLPHs have been reported to occur in men; therefore, not all cases of MPLHs represent metastases from a uterine smooth muscle tumor. Because these lesions represent a tumorlike overgrowth of normal tissue, we think that leiomyomatous hamartoma is an appropriate term to designate this entity. The possible influence of inflammatory cell mediators in the pathogenesis of MPLHs remains speculative.

Air cysts and bronchiectasis prevail in nondependent areas in severe acute respiratory distress syndrome: a computed tomographic study of ventilator-associated changes.

OBJECTIVE: To investigate prevalence and spatial distribution of air cysts and bronchiectasis associated with mechanical ventilation in patients with severe acute respiratory distress syndrome. DESIGN: Retrospective observational study. SETTING: University hospital intensive care division. SUBJECTS: A total of 21 patients with severe acute respiratory distress syndrome requiring prolonged mechanical ventilation and undergoing thoracic computed tomographic scanning. MEASUREMENTS AND MAIN RESULTS: Lung fields were anatomically divided according to functional bronchial divisions in ten segments on each side. Air cysts, bronchiectasis, and the percentage of normal and abnormal tissue were quantified for each segment and correlated to the duration and variables of mechanical ventilation. Air cysts prevailed in nondependent compared with dependent areas (38% +/- 5% vs. 9% +/- 3%, respectively; p <.01). With mechanical ventilation longer than 10 days, the odds ratio was 13.1 (95% confidence interval, 1.4-118.7) for air cysts and for bronchiectasis 17.6 (95% confidence interval, 2.8-109.6). The amount of abnormal parenchyma correlated with duration of mechanical ventilation on high end-inspiratory pressure but not with tidal volume or minute ventilation. The presence of pneumothorax was not correlated with ventilation settings but with the amount of consolidated tissue revealed by the computed tomographic scan. CONCLUSIONS: These findings suggest predominant ventilator-induced lung damage in better ventilated areas (i.e., nondependent regions). Severity of changes revealed by computed tomographic imaging seems to be associated mainly with the high inspiratory pressures required and the length of mechanical ventilation.

The bronchial cast syndrome after the fontan procedure: further evidence of its etiology.

We describe a three-year-old boy who presented with recurrent expectoration of bronchial casts six months following creation of a fenestrated lateral tunnel Fontan circulation for pulmonary atresia with intact ventricular septum. Cardiac catheterization demonstrated elevated central venous pressure with two areas of stenosis within the Fontan circuit, specifically at the junction of the right superior caval vein and the right pulmonary artery, and between the atrial baffle and the right superior caval vein. Insertion of Palmaz stents in these areas resulted in a reduction in central venous pressure, and a transient reduction in production of casts. Eight weeks after catheterization, however, he produced further casts, which resulted in hypoxia, respiratory arrest and death. We reviewed the autopsied specimens obtained from patients with the Fontan circulation over an eleven-year period at our institution in order to ascertain the prevalence of subclinical production of bronchial casts. We found no casts in the thirteen patients examined. Hemodynamic assessment is vital in all patients who develop this syndrome, and should be the primary focus of investigation, rather than solely directing efforts at lysis of casts.

Quiste broncogénico (a propósito de un caso) / Bronchogenic cyst (a propos of a case)

Antecedentes: los quistes broncogénicos son una malformación congénita del árbol bronquial que a menudo son asintomáticos. Frecuentemente se manifiestan como un hallazgo radiológico. Objetivo: presentar un caso de quiste broncogénico sintomático en un adulto, tratado quirúrgicamente en nuestro hospital. Se hacen consideraciones etiológicas y clínico-quirúrgicas. Lugar de aplicación: Servicio de Cirugía General, Hospital Interzonal General de Agudos Presidente Perón, Avellaneda. Material y métodos: se presenta un paciente de sexo femenino de 42 años de edad, intervenido quirúrgicamente en nuestro hospital. Se utilizan para la recolección de datos la historia clínica, estudios de imágenes (radiografía de tórax, TAC de tórax, RMN de tórax) y los protocolos quirúrgicos. Resultados: se expone el tratamiento quirúrgico, los controles postoperatorios, la mejoría de la función, la desaparición de los síntomas. Conclusiones: si bien, generalmente son asintomáticos, y en los adultos se presentan como hallazgos radiológicos, en ciertos casos por su localización pueden dar origen a importantes síntomas funcionales y respiratorios, por lo cual se sugiere tratamiento quirúrgico una vez realizado el diagnóstico, ya que las cirugías de las complicaciones revelan mayor dificultad y resultados ominosos