Ichimura Hideo, Ozawa Yuichiro, Shiigai Masanari, Shiotani Seiji, Kikuchi Kazunori, Sato Yukio
Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 2-1-1 Jyounan, Hitachi, Ibaraki, 317-0077, Japan.
Department of Thoracic Surgery, Hitachi General Hospital, Hitachi, Japan.
Surg Case Rep. 2017 Dec;3(1):1. doi: 10.1186/s40792-016-0282-y. Epub 2017 Jan 3.
A mediastinal air cyst is a rare computed tomography (CT) finding. Once the lesion is identified, it is difficult to diagnose and treat. Meanwhile, bronchial diverticula have been reported as a CT finding observed in certain pulmonary pathologic conditions. We encountered the case of an enlarged mediastinal air cyst accompanied with bronchial diverticula and upper lobe-dominant fibrous changes of the lung.
A 69-year-old man with a chronic cough who had regularly visited a chest physician for upper lobe-dominant pulmonary fibrosis was referred to our hospital for the examination of an enlarged mediastinal air cyst. Chest CT exhibited an air cyst (size, 30 mm) connected to the lumen of the left main bronchus (LMB) and multiple tiny outpouches only on the LMB. Flexible bronchoscopy showed bubbling from slits or indentations of the bronchial mucosa only in the LMB but not in the right main bronchus or lobar bronchus. For therapeutic diagnosis, we removed the air cyst. Based on clinical, surgical, and pathological findings, we diagnosed the air cyst as an enlarged bronchial diverticulum.
This is the first case wherein bronchoscopic and surgical findings of bronchial diverticula and an enlarged bronchial diverticulum are reported. There are possible pathogenic mechanisms in cases of pulmonary disease that are attributable to enlargement of the bronchial diverticula.
纵隔气囊肿是一种罕见的计算机断层扫描（CT）表现。一旦发现该病变，诊断和治疗都很困难。同时，支气管憩室已被报道为在某些肺部病理状况下观察到的一种CT表现。我们遇到了一例伴有支气管憩室及上叶为主的肺部纤维改变的纵隔气囊肿增大的病例。
一名69岁有慢性咳嗽的男性，因上叶为主的肺纤维化定期就诊于胸科医生，现因纵隔气囊肿增大被转诊至我院检查。胸部CT显示一个与左主支气管（LMB）管腔相连的气囊肿（大小为30mm），且仅在左主支气管上有多个微小的囊袋状突出。可弯曲支气管镜检查显示仅在左主支气管的支气管黏膜裂隙或压痕处有气泡冒出，而右主支气管或叶支气管未见。为进行治疗性诊断，我们切除了气囊肿。基于临床、手术及病理检查结果，我们将该气囊肿诊断为增大的支气管憩室。
本文首次报道了支气管憩室及增大的支气管憩室的支气管镜和手术检查结果。支气管憩室增大可能是肺部疾病的致病机制之一。
