An unusual cause of respiratory distress

Background: Respiratory distress is a very common presenting complaint in children and neonates, and is one that will regularly face healthcare professionals. A thorough clinical assessment and sound appreciation of the broad range of differential diagnoses is key to enabling effective and subsequent targeted investigation and management of the condition. Bronchogenic cysts, while rare, are one of the most common mediastinal masses encountered in the neonate. The clinical presentation of bronchogenic cysts is variable, however in the neonate they often present with respiratory distress shortly after birth. Radiological appearances are rarely conclusive, with histology required for a definitive diagnosis.

Case: Presented here is a case of a term infant who developed respiratory distress shortly after birth that required intubation and ventilation. Antenatal ultrasound demonstrated a persistent posterior mediastinal cystic structure.

Investigations: Chest radiographs obtained shortly after birth revealed a smooth, well-defined homogenous mediastinal mass, with left lung hyperinflation. Subsequent computed tomography confirmed that the mass was closely related to the trachea anteriorly and oesophagus posteriorly, displacing both of these structures to the right.

Differential diagnosis: Differential diagnosis was of an oesophageal duplication cyst or bronchogenic cyst.

Treatment: After stabilisation on the neonatal intensive care unit, the infant was transferred to a tertiary centre for definitive management. Thoracotomy was performed, and histopathology of the mass confirmed the diagnosis of a bronchogenic cyst.

Outcome and follow up: The infant made an uneventful recovery, and was discharged 17 days post-operatively. She has since been discharged from formal follow up and displays no respiratory complications.

Discussion: This case serves as a reminder to the reader that, although uncommon, bronchogenic cysts should be considered in the differential diagnosis, particularly when assessing the newborn infant with respiratory distress. As such, it provides an important educative value. It also serves to highlight the importance of careful radiographic imaging and interpretation. While often not diagnostic, when used in conjunction with good clinical assessment, imaging can help to narrow the differential diagnosis and subsequently focus the investigation and management.