Pedunculated parietal pleural lesion: a rare presentation of bronchogenic cyst.
ABSTRACT We present a 35-year-old man with a preoperative diagnosis of a right lower lobe cystic mass. Misled by a radiological suggestion of an intraparenchymal lesion, he had a thoracotomy and right lower lobectomy. An intraoperative finding of a pedunculated cyst arising from the parietal pleural with subsequent histopathology confirmation of a benign bronchogenic cyst, however, would have made a less invasive surgical excision more appropriate.
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ABSTRACT: To characterize the imaging features of bronchogenic cysts. The computed tomographic (CT) and/or magnetic resonance (MR) or ultrasonographic images in 68 histopathologically proved cases of bronchogenic cyst in 38 male and 30 female patients, aged newborn to 72 years (mean, 22 years), were retrospectively reviewed. There were 58 mediastinal and 10 extramediastinal cysts. At CT (n = 62), 60 cysts were sharply marginated with smooth (n = 35) or lobulated (n = 25) borders. Twenty-five cysts were of water attenuation, 25 were of soft-tissue attenuation, two were air filled, two had an air-fluid level, and two had dependent milk of calcium. On T1-weighted MR images (n = 23), 18 cysts were hyperintense and five were isointense to cerebrospinal fluid. On T2-weighted MR images (n = 18), 17 cysts were isointense or hyperintense to cerebrospinal fluid. Of the 25 soft-tissue-attenuation lesions at CT, 11 appeared cystic because of internal homogeneity, lack of internal enhancement, mural enhancement, and characteristic location. Fourteen appeared solid based on morphology and attenuation. MR imaging of nine of the latter showed marked hyperintensity on T2-weighted images. CT of bronchogenic cysts typically shows sharply marginated mediastinal masses of soft-tissue or water attenuation. Most appear cystic. A minority appear solid and can be confused with other lesions; MR imaging can be useful for elucidating the cystic nature of these lesions.Radiology 12/2000; 217(2):441-6. · 6.34 Impact Factor
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ABSTRACT: Cysts and cavities are commonly encountered abnormalities on chest radiography and chest computed tomography. Occasionally, the underlying nature of the lesions can be readily apparent as in bullae associated with emphysema. Other times, cystic and cavitary lung lesions can be a diagnostic challenge. In such circumstances, distinguishing cysts (wall thickness < or = 4 mm) from cavities (wall thickness > 4 mm or a surrounding infiltrate or mass) and focal or multifocal disease from diffuse involvement facilitates the diagnostic process. Other radiological characteristics, including size, inner wall contour, nature of contents, and location, when correlated with the clinical context and tempo of the disease process provide the most helpful diagnostic clues. Focal or multifocal cystic lesions include blebs, bullae, pneumatoceles, congenital cystic lesions, traumatic lesions, and several infectious processes, including coccidioidomycosis, Pneumocystis carinii pneumonia, and hydatid disease. Malignant lesions including metastatic lesions may rarely present as cystic lesions. Focal or multifocal cavitary lesions include neoplasms such as bronchogenic carcinomas and lymphomas, many types of infections or abscesses, immunologic disorders such as Wegener granulomatosis and rheumatoid nodule, pulmonary infarct, septic embolism, progressive massive fibrosis with pneumoconiosis, lymphocytic interstitial pneumonia, localized bronchiectasis, and some congenital lesions. Diffuse involvement with cystic or cavitary lesions may be seen in pulmonary lymphangioleiomyomatosis, pulmonary Langerhans cell histiocytosis, honeycomb lung associated with advanced fibrosis, diffuse bronchiectasis, and, rarely, metastatic disease. High-resolution computed tomography of the chest frequently helps define morphologic features that may serve as important clues regarding the nature of cystic and cavitary lesions in the lung.Mayo Clinic Proceedings 06/2003; 78(6):744-52. · 5.79 Impact Factor