| Objective: To explore the clinical and imaging characteristics of Mediastinal Bronchogenic Cysts in children to provide reliable imaging basis for preoperative diagnosis and treatment.Methods: Clinical and imaging data of 30 children with mediastinal bronchiogenic cyst who were confirmed by surgery and pathology from July 2008 to May 2018 in Children's Hospital Affiliated to Chongqing Medical University were retrospectively analyzed.Results:1.Clinical manifestationNo accompanying symptoms were found in 8 cases(26.7%)due to physical examination.22 cases(73.3%)were associated with clinical symptoms,of which cough was the most common,with 19 cases(63.3%).Other symptoms include:10 cases(33.3%)of roar asthma,7 cases of fever(23.3%),2 cases(6.7%)of interlaryngeal sputum noise,1 case of chest tightness(3.3%),1 case of expectoration(3.3%),1 case of hemoptysis(3.3%),1 case of dysphagia(3.3%),and 1 case of headache(3.3%).17 cases(56.7%)had two or more clinical symptoms.The interval between symptoms and diagnosis ranged from two days to two years,with a median of 20.0 days.Some of these symptoms appear in a gradual way,4 cases(13.3%)of these symptoms exacerbated later.2.Imaging findings16 cases(53.3%)were located in middle mediastinum,posterior mediastinum in 6 cases(20.0%)and 8 cases(26.7%)involved in middle and posterior mediastinum.None occurred in the anterior mediastinum.The cysts were located in paratracheal region in 11 cases(36.7%),hilus pulmonis region in 8 cases(26.7%),Paravertebral space in 6 cases(20.0%),subcarinal angle in 4 cases(13.3%)and paraesophageal in 1 case(3.3%).The maximum cyst axial diameter was 19.5mm ~ 59.0mm,average(34.39±10.85)mm.There was no statistically significant difference between the size of the cyst in the symptomatic group and the non-symptomatic group(P >0.05).23 cases(76.7%)were round or oval.7 cases(23.3%)were irregular.3 cases(10.0%)were visible separated for multiple rooms.In 22 cases(73.3%),bronchial trees were compressed,displaced and narrowed.The esophagus was compressed and displaced in 8 cases(26.7%).7 cases(23.3%)had pleural lesions.Compression of adjacent vessels(pulmonary vessels and superior vena cava)in 2 cases(6.7%);1 case(3.3%)was associated with scoliosis.CT scan was performed in 29 cases,including CT enhanced scan in 25 cases.The cyst CT value ranged from 3.3~45.5HU.In contrast-enhanced scan,24 cases had no enhancement of cystic contents and cystic wall enhanced,1 case had uneven thickness of cyst wall.1 cases of cystic contents were slightly strengthened and the wall was not definite.CT manifestations were 1a type in 16 cases(55.2%),1b type in 2 cases(6.9%),2a type in 10 cases(34.5%),2b type in 1 case(3.4%)and no type 3 cyst was found.There was no statistically significant difference between the clinical symptoms of type 1 MBC and type 2 MBC.MRI scan was performed in 11 cases,including MRI enhanced scan in 7 cases.11 cases(100.0%)of T2 WI showed homogeneous hyperintensity,similar to CSF.6 cases(54.5%)showed homogeneous hypointense on T1 WI,4 cases(36.4%)showed homogeneous isointensity on TIWI,and 1 case(9.1%)showed heterogeneous signal on TIWI.The enhancement of the cystic wall was seen in all 7 cases,but no significant enhancement was observed in the contents of the cyst.CT and MRI scan were performed in 10 cases,including 7 cases of type 1a,1 case of type 1b,1 case of type 2a and 1 case of type 2b.3.Intraoperative observation18 cases(60.0%)of the cyst contents were fluid and 12 cases(40.0%)were gelatinous.The CT value of the cyst of the fluid group was significantly different from that of the gelatinous contents group(T =-3.581,P<0.05).4.HistopathologyThere were 29 cases of ciliated columnar epithelium and 1 cases of squamous epithelium.There were 13 cases(43.3%)of bronchial glands,10 cases(33.3%)of smooth muscle,9 cases(30.0%)of cartilage,9 cases(30.0%)of inflammatory cell infiltration,2 cases(6.7%)with hemorrhage and necrosis and 1 case of calcification(3.3%).Conclusions:1.Bronchogenic cyst is a rare congenital disease caused by abnormal germination of lung buds.It occurs mostly in mediastinum.2.The clinical manifestations of bronchogenic cysts vary greatly and may not be accompanied by clinical symptoms.Some children have clinical symptoms,but none of them are specific,Some of the them are aggravated in the later.3.CT findings of most mediastinal bronchogenic cysts are typical.however,a small number of mediastinal bronchogenic cysts are not typical,such as increased cyst content density,cyst content enhancement,thickening of the cyst wal,uncertain cyst wall,blurred cyst boundary,easily confused with other diseases,resulting in misdiagnosis.4.MRI is more advantageous in determining the cystic nature of bronchogenic cysts,so the selection scheme of imaging examination should be optimized to improve the accuracy of image diagnosis... |
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