Treatment of mediastinal bronchogenic cyst by rigid bronchoscopy and laser

Bronchogenic cyst (BC) of the mediastinum in infancy is a rare lesion. They sometimes produce severe recurrent bouts of respiratory distress that may have leathal outcomes if not recognized. BCs are benign congenital malformations of the primitive ventral foregut, that can present at any age. The diagnosis is often suspected by clinical symptoms and later on confirmed by endoscopic and radiologic evaluation.

A 6-month-old infant with persistent respiratory distress had recurrent admissions to Paediatric Intensive Care Unit. The infant was managed as a case of bronchiolitis, which led to ineffective treatment on numerous occasions. Radiological work-up revealed unusual findings of asymmetrical hyperinflation, with hyperinflation occurring in both lungs but it is more noticeable in right one by a ball-valve effect. Bronchoscopy, was performed with the primary intention to retrieve a possible foreign body, showed a non-pulsatile external mass compressing the entry of the main bronchi with more pressure on the right main bronchus. A bronchogenic cyst was suspected and confirmed by computed tomography. Bronchoscopic management with laser was performed, with no reported complications or recurrence after a 10 month follow-up.

In infants presenting with respiratory distress and no signs of infection, the differential diagnosis of BC should be considered. These pathologies are commonly treated by open or minimal invasive surgery. This is a report of an infant presenting with a BC that was successfully treated by rigid bronchoscopy and laser as a novel alternative approach.