Infected Bronchogenic Cyst with Mycobacterium tuberculosis as a Cause of Respiratory Distress: A Case Report

Ezekiel Olayiwola Ogunleye (1), Oyebola Olubodun Adekola (2), Olugbenga Oluseyi Olusoji (1), Augustine Jeremai Olugbemi (1), Saheed Babatunde Sanni (1)

1. Department of Surgery, Cardiothoracic Surgical Unit, College of Medicine, University of Lagos, Lagos, Nigeria

2. Department of Anaesthesia, College of Medicine, University of Lagos, Lagos, Nigeria

Correspondence to: Saheed Babatunde Sanni; email sannisaheed@yahoo.com

Received: 20 Nov 2020; Revised: 12 Dec 2021; Accepted: 27 Dec 2021; Available online: 22 Jan 2022

 

Abstract

Bronchogenic cyst is a common primary cyst of the mediastinum, and it is usually located in the middle mediastinum and intrapulmonary regions. Bronchogenic cysts are lesions of congenital origin that occur due to abnormal budding from the primitive ventral foregut. They are common in the pediatric age group and have symptoms of respiratory distress, recurrent cough, wheezing, and stridor. Definitive management involves surgical excision. We herein report our experience of a bronchogenic cyst complicated by Mycobacterium tuberculosis infection in an 8-month-old infant. The patient underwent a right posterolateral thoracotomy, and an intrapulmonary bronchogenic cyst filled with purulent fluid was excised. The patient was given anti-tuberculous medication, and the post-operative outcome was good.

 

Keywords: Bronchogenic cysts, Mycobacterium tuberculosis, Respiratory distress

Ann Afr Surg. 2022; 19(3): 161-164

DOI: http://dx.doi.org/10.4314/aas.v19i3.6

Funding: None

© 2022 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.

Introduction 

Bronchogenic cyst is a congenital bronchopulmonary malformation resulting from abnormal ventral budding of the tracheobronchial tree during embryogenesis. It usually occurs between 26 and 40 days of gestation, with subsequent separation from the normally developing bronchi by 16 weeks of gestation. Early separation before 12 weeks leads to a mediastinal location of the cyst, whereas delayed separation results in a more peripheral location such as intrapulmonary parenchyma (1). The epithelial lining of the cyst is usually pseudo-stratified columnar epithelium, and the wall consists of smooth muscle, cartilage, elastic tissue, and mucous glands. Bronchogenic cysts are usually unilocular and contain clear fluids devoid of air since they do not communicate with the tracheobronchial lumen. Infection of the cyst may cause the liquid content to become purulent. The cysts are mostly located in the mediastinum and lung parenchyma, but rarely in other locations (2). Data on the management of an infected bronchogenic cyst with Mycobacterium tuberculosis are very sparse in our setting. We, therefore, report the case of an 8-month-old child with an intrapulmonary bronchogenic cyst that was infected with M. tuberculosis. The cyst was successfully managed by surgical excision and post-operative anti-tuberculous medication.

Case Presentation

An 8-month-old female infant was brought to our facility with a 6-week history of respiratory distress with increasing severity and associated cough, wheezing, and stridor. Fever and weight loss were absent, and there was no documented contact with anybody with infective cough or tuberculosis. Previous trials of antibiotics and inhaled bronchodilator for presumed bronchopneumonia and asthma, respectively, were unsuccessful. The infant was born in the UK after a 9-month pregnancy, and delivery was uneventful. She was brought to Nigeria at the age of 4 months in good health, but she developed respiratory symptoms after 10 weeks of residing in Nigeria.She was not vaccinated at birth against tuberculosis, but she was exclusively breastfed for 6 months, and her developmental milestones were normal for her age. She is the first child of well-educated parents who reside in the UK. Clinical examination revealed a well-nourished infant who was obese (>90th percentile compared with standard weight for age) and in severe respiratory distress, with expiratory stridor and wheezing. There were paroxysms of cough punctuating the clinical examination. Temperature was normal, with mild to moderate pallor. The respiratory rate was 88 cycles per minute, with moderately reduced air entry in the middle and lower zones of the right hemithorax. Only the first and second heart sounds were present, with mild tachycardia. All other systems were essentially normal. Her weight was 10 kg (>90th percentile), serum chemistry was normal, hematological profile showed mild leukocytosis (14,000/µL), with lymphocytic predominance, and increased erythrocyte sedimentation rate; the retroviral status was negative.Chest x-ray (Figure 1) showed a well-defined oval-shaped homogenous opacity in the right mid-zone extending from the cardiac border to the chest wall laterally.Computerized tomography scan of the ches