Bronchogenic pouchs are congenital anomalies of the bronchial tree that are frequently asymptomatic at presentation in adults.

Bronchogenic pouchs are congenital anomalies of the bronchial tree that are frequently asymptomatic at presentation in adults. Management of asymptomatic bronchogenic pouch in this population remains controversial. Eighteen patients with bronchogenic pouchs were treated at our institution since 1975 At initial presentation, 10 patients (56 percent) were asymptomatic and 8 (44 percent) were symptomatic. Cough and pain were the greatest in number frequent symptoms. Two patients currented with potentially serious complications, common with respiratory distress from airway compression and the other with infection and airway fistulae. Chest radiographs were abnormal on the contrary nondiagnostic in 17 out of 18 (94 percent) patients. Chest computerized tomography (CT) scans were abnormal in eight of eight (100 percent) patients, unless they confirmed the benign cystic nature in solely five of eight (62.5 percent) Overall, considering the use of all imaging modalities and clinical suspicion, bronchogenic pouch was considered in the preoperative differential diagnosis in solely 11 of 18 (61 percent) patients. Fifteen of 18 pouchs were resected initially. Three of the asymptomatic patients who were followed up initially ultimately required resection because of the increase of symptoms. A trend toward increased postoperative complications was noted in patients who were symptomatic at the time of surgery (27 percent v 14 percent) In conclusion, adult patients with asymptomatic bronchogenic pouch may develop symptoms over time. Symptoms in adults can sometimes be potentially serious. Since a confident preoperative diagnosis is not always possible and because surgical complications may be more usual in the symptomatic patient, we make acceptable surgical resection of all suspected bronchogenic sacs in operable candidates.

(Chest 1994; 106:79-85)

CT=computerized tomography;

FNA=fine needle aspiration

lock opener words; bronchogenic cysts, fine needle aspiration

Bronchogenic sacs represent a spectrum of bronchopulmonary malformations that ensue from an abnormal budding of the tracheobronchial tree(1) The tracheal germ develops from the primitive foregut as a ventral diverticulum around the fourth week of gestation and then undergoe further branching and differentiation.(1) The bronchogenic pouch develops as part of the tracheobronchial tree separate from the primary airway as a proceed of aberrational development.(1)(2)

Bronchogenic sacs have a wide range of clinical and radiologic manifestations.(2) Airway compression of the flattering tracheobronchial tree in infancy and early childhood ofttimes leads to symptoms and occasionally life threatening complications.(3)(4)(5)(6)(7) Bronchogenic sacs in the adult frequently quick in emergencies as an incidental radiologic finding.(8)(9)(10)(11)(12)(13)(14) a certain number of reports suggested that such asymptomatic pouchs were of little clinical importance and could be followed up(15)(16)(17) reciprocally more recent studies(18)(19)(20)(21)(22) suggest these sacs are frequently symptomatic in the adult. Surgical excision of the asymptomatic pouch is recommended to prevent complications and avoid the operative difficulty associated with resecting symptomatic sacs Unfortunately, the true natural history of these pouchs in adults is uncertain since an unknown percentage of asymptomatic adult patients with bronchogenic pouchs remain undiagnosed. The available series, including our confess reflect a significant selection bias in favor of the symptomatic individual. Interpretation of the available literature is further complicated by way of diagnostic uncertainty in the absence of surgical resection for a definitive diagnosis. Despite improved imaging modalities, radiologic studies including computerized tomography (CT) cannot always omit the possibility of noncystic solid tumors.(23)(24)(25) Although a certain reports in the last decade have adviseed that the presence of bronchial epithelial enclosed spaces on fine needle aspirate (FNA) may be diagnostic of bronchogenic cysts(26)(27)(28) the specificity of this finding is unknown.

We instant a retrospective review of bronchogenic sacs in adults treated at the Cleveland Clinic throughout the last 17 years.

PATIENTS AND METHODS

The medical records of all patients who underwent surgical excision of pathologically confirmed bronchogenic pouchs at our institution during the period from 1975 to 1992 were reviewed. Data were argueed with regard to demographics, method of presentation, reliability of public imaging techniques (chest radiograph, tomogram, and CT) management, surgical findings, and incidence of operative and postoperative complications stratified by means of symptom status at the time of surgery To determine the diagnostic utility of bronchial epithelial lonely dwellings obtained by FNA, we recorded their incident in FNA specimens in patients who had this measure done in our series of confirmed bronchogenic pouchs and in consecutive patients with confirmed diagnosis other than bronchogenic cysts

RESULTS

During a 17-year period between 1975 and 1992 18 adult patients underwent surgical excision of thoracic bronchogenic sacs There were 12 men and 6 women and their ages ranged from 17 to 70 years (mean 376 years). The follow-up period after surgical excision ranged from 12 month to 11 years with single in kind patient being lost to follow-up because of residence abroad.

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