Thoracoscopic Resection of a Bronchogenic Cyst Located at the Thoracic Inlet

Abstract

Introduction:

Bronchogenic cysts are a type of foregut duplication cyst. They can appear in several different locations in the mediastinum. Controversy exists over the best method by which to excise cysts that are located at the thoracic inlet. Thoracoscopic resection of mediastinal masses, including bronchogenic cysts, has been well described in children. ^{1 –4} However, the majority of case reports of bronchogenic cysts and other mediastinal masses located at the thoracic inlet have been resected through thoracotomy, a cervical incision, or a combination of the two. ^5,6 This is the first case report on complete thoracoscopic excision of a bronchogenic cyst located at the thoracic inlet.

Materials and Methods:

The patient is a 9-month-old female who presented to the Emergency Department with progressive stridor for 3 weeks. Her symptoms did not improve despite trying a regimen of antibiotics and steroids. A chest X-ray and neck X-ray showed significant tracheal deviation. Bronchoscopy revealed tracheal compression by an external source. CT scan confirmed a mass at the thoracic inlet compressing the trachea and extending inferiorly to ∼2 cm above the carina. The decision was made to approach the mass thoracoscopically. One 5-mm port was used for the camera. One 5-mm port, one 3-mm port, and one 3-mm stab incision were used for exposure and dissection. Upon placing the camera in the chest, a bulge from the cyst was seen lying posterior to the subclavian vessels and anterior to the aorta. Once the cyst was exposed, a combination of blunt and sharp dissection was performed to mobilize the cyst. The cyst was decompressed to ease the dissection. As medial dissection of the cyst proceeded, attachment to the cricopharyngeus muscle was visualized. Dissection proceeded through a translucent plane between the cyst and the esophagus until the cyst came off completely. Once the cyst was removed, the trachea and the esophagus were clearly seen at the medial dissection plane. These structures appeared grossly intact.

Results and Conclusions:

The patient did well overall postoperatively. Her course was complicated by development of an asymptomatic esophageal diverticulum and a left recurrent laryngeal nerve traction injury. She has recovered well from both of these conditions. Complete thoracoscopic excision of bronchogenic cysts at the thoracic inlet can be performed safely. However, complications can happen with any type of resection that is performed at this location. Expectations should be set accordingly with family members regarding possible complications.

The authors have no disclosures. No competing financial interests exist.

Runtime of video: 5 mins