Cervical Bronchogenic Cyst Causing Inspiratory Stridor

Introduction: Bronchogenic cyst is a rare congenital pulmonary malformation, which is a consequence of abnormal budding of the foregut. 85% of bronchogenic cysts are found in the mediastinum. However, unusual locations such as the neck, pericardium or abdomen have been reported. We present a case of a bronchogenic cyst at the cervical region extending to the superior mediastinum.

Case Report: A 2-month-old baby girl presented to the hospital on day 13 of life with profound noisy breathing. There was an inspiratory stridor and mild subcostal and intercostal recession onexamination. Chest X-ray revealed hyper-inflated lungs. Nasopharyngolaryngoscopy revealed redundant arytenoid tissue which prolapsed into the airway during inspiration and provisional diagnosis was laryngomalacia. A Computed tomography of thorax revealed a homogenous hypodense mass located on the left of trachea at the superior mediastinum compressing the trachea and displacing it to the right. Cystic mass was excised and histopathological examination interpreted as bronchogenic cyst.

Discussion: Children with bronchogenic cyst can present with breathlessness, cough, wheeze, or stridor while 20% of them are asymptomatic. Computed tomography provides information regarding the location of the mass and degree of upper airway narrowing. Complete surgical excision is the standard management even in asymptomatic patients in order to prevent complications and avoid malignant transformation.

Conclusion: Patients who do not respond to conventional treatment for wheezing or stridor, require further investigations to confirm the diagnosis. Multidisciplinary discussion should be carried out to decide the best timing and approach of surgery in order to achieve the best outcome.