Frye Stacy A, Decou James M
Grand Rapids Medical Education Center Pediatric Residency Program, Michigan State University, Helen DeVos Children’s Hospital,330 Barclay Avenue NE, Suite 300, Grand Rapids, MI 49503, USA.
Cases J. 2009 Sep 10;2:8070. doi: 10.4076/1757-1626-2-8070.
Bronchogenic cysts are lesions of congenital origin derived from the primitive foregut and are the most common primary cysts of the mediastinum. They are most frequently unilocular and contain clear fluid. Respiratory distress is the most common presentation in pediatric patients, manifested by recurring episodes of cough, stridor, wheezing and retractions.
We report the first pediatric case of bronchogenic cyst complicated by atypical Mycobacterium infection. This case describes a 13-year-old Caucasian American female with a large cystic lesion and extensive pulmonary involvement. Pathology studies revealed necrotizing granulomatous inflammation, multiple nodules, and acid-fast bacilli. She was successfully treated with surgical excision and a six-week course of clarithromycin, rifampin and ethambutol. Other unusual aspects of this case include multilocular intraparenchymal cyst appearance, its turbid drainage, and late symptom onset.
Bronchogenic cyst should be included in the differential diagnosis of a child with cough, dyspnea, and fever. Although rare, we stress the importance of keeping mycobacterial infection in mind in cases of an infected cyst. Acid-fast culture should be done on sputum and cyst contents. Due to the frequency of negative cultures, stains should also be performed on resected cyst specimens. Antibiotic therapy should be considered and administered based on the extent of infection. All symptomatic or enlarging cysts warrant surgical excision. Prophylactic removal of asymptomatic cysts is recommended due to higher rates of perioperative complications once cysts become symptomatic.
支气管源性囊肿是源自原始前肠的先天性病变，是纵隔最常见的原发性囊肿。它们最常为单房性，内含清亮液体。呼吸窘迫是儿科患者最常见的表现，表现为反复咳嗽、喘鸣、喘息和吸气性凹陷发作。
我们报告了首例合并非典型分枝杆菌感染的儿科支气管源性囊肿病例。该病例描述了一名13岁的美籍高加索女性，患有一个大的囊性病变并伴有广泛的肺部受累。病理研究显示坏死性肉芽肿性炎症、多个结节和抗酸杆菌。她通过手术切除以及为期六周的克拉霉素、利福平及乙胺丁醇治疗而成功治愈。该病例的其他不寻常之处包括实质内多房性囊肿外观、浑浊的引流液以及较晚出现的症状。
对于咳嗽、呼吸困难和发热的儿童，支气管源性囊肿应列入鉴别诊断范围。尽管罕见，但我们强调在囊肿感染病例中要考虑分枝杆菌感染的重要性。应对痰液和囊肿内容物进行抗酸培养。由于培养结果常为阴性，因此还应对切除的囊肿标本进行染色检查。应根据感染程度考虑并给予抗生素治疗。所有有症状或增大的囊肿均需手术切除。鉴于囊肿出现症状后围手术期并发症发生率较高，建议对无症状囊肿进行预防性切除。
