Subcutaneous bronchogenic cysts.

Recent experience with a bronchogenic cyst occurring in a subcutaneous suprasternal location presents an additional entity to be considered in the differential diagnosis of head and neck lesions, and correlates with the embryology of the developing tracheobronchial tree and sternum. A review of subcutaneous bronchogenic cysts shows 41 cases have been described in the English literature. Most were noted in the suprasternal location; all but one were first noted in infancy or childhood. There is a definite male predominance. Sinus tracts were present in four cases, but none extended into the chest or mediastinum. Although local excision led to cure in all cases, incomplete excision in two cases required reoperation. Embryologic maldevelopment is suggested as the etiology for subcutaneous bronchogenic cysts, with a "pinching off" of pulmonary parenchyma by closure of the developing lateral sternal bars, fusion of which results in an isolated bronchogenic cyst in the subcutaneous tissues of the anterior chest wall. Awareness of this lesion by pediatric surgeons in the differential diagnosis of masses or sinuses presenting in the suprasternal region may prevent incomplete excision of components, which can extend deep into the site of origin. The possibility of extension into the mediastinum should be entertained.