Bronchogenic and pericardial cysts: Resect or observe

Bronchogenic cysts are the most common cystic lesions in the mediastinum representing 15-25% of all mediastinal masses.¹ They are the most common congenital foregut cyst and comprise 60% of mediastinal cysts. ² The prevalence of bronchogenic cysts is 1:68,000 admissions. ³ They arise from abnormal budding of the tracheobronchial tree4 and, thus, are found along the anterior aspect of the esophagus, around the trachea, and in the mediastinum, hilum and lung. Depending upon when the cyst separates from the developing foregut it can be found in the neck, along the vertebrae, pericardium, subdiaphragmatic space and in other sites. Bronchogenic cysts can develop infection, compress and/or irritate adjacent vital structures and spontaneously hemorrhage. Fistulae have been reported to be as high as 43% in symptomatic patients,⁵ accounting for 53% of the major complications associated with cysts.⁶ Fifty-five percent of bronchogenic cysts have significant pericystic adhesions to mediastinal structures⁷; their presence makes surgical resection difficult.