Bronchogenic Cyst Diagnosed by Bronchoscopy with Endobronchial Ultrasound (EBUS) and Transbronchial Needle Aspiration (TBNA)—A Case Report and Review of the Literature

Abstract

Lower respiratory tract anomalies are not commonly encountered in clinical practice, specifically with regards to adult medicine. Bronchogenic cysts, in particular, are rare anomalies that may present as a diagnostic challenge for most clinicians, especially if the patient is asymptomatic. Furthermore, presenting symptoms are often non-specific, and imaging may be misleading. Historically, gold standard for diagnosis requires surgical resection and pathological evaluation. However, there may be a role for bronchoscopy and endobronchial ultrasound (EBUS) with transbronchial needle aspiration (TBNA) in the diagnosis and, potentially, treatment of bronchogenic cysts. The patient was referred to pulmonary for abnormal imaging. A computed tomography scan of the chest revealed a mediastinal mass that was initially concerning for malignancy. After undergoing bronchoscopy with EBUS, it was determined based on ultrasound that the lesion in question was in fact cystic in nature. Furthermore, TBNA of the lesion yielded serous fluid and resulted in shrinkage of the lesion. There are several peer-reviewed, published case reports detailing the use of bronchoscopy with EBUS-TBNA to aid in diagnosis of bronchogenic cysts. The obvious advantage of this method is potentially avoiding unnecessary surgery. However, there are also case reports detailing potentially fatal adverse events from performing needle aspiration of bronchogenic cysts, the most devastating being mediastinitis. Further data is needed regarding the utility and safety of bronchoscopy with EBUS-TBNA in diagnosing and managing bronchogenic cysts.