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• W4304092566 abstract "SESSION TITLE: Diagnosis of Lung Disease through Pathology Case PostersSESSION TYPE: Case Report PostersPRESENTED ON: 10/19/2022 12:45 pm - 01:45 pmINTRODUCTION: 50% of masses occur in the anterior mediastinum and are commonly due to thymoma, teratoma, thyroid disease, and lymphoma. A bronchogenic cyst is a bronchopulmonary congenital malformation that arises from abnormal tracheobronchial tree budding. Its finding may be incidental or due to one of its complications. It is diagnosed via imaging. Surgical excision may be recommended.CASE PRESENTATION: A 64-year-old female with a history of hypertension presented to the emergency room (ER) with complaints of abdominal pain, nausea, and headaches. In the ER, vitals and physical exam were unremarkable. Laboratory findings were significant for sodium of 125 mmol/L, chloride of 87 mmol/L, white cell count of 10.5 B/L, and hemoglobin of 12.3 g/dL. She had a chest X-ray that raised concerns of a widened mediastinum. As a result, CTA chest pulmonary angiography was ordered which showed an anterior mediastinal mass with a minimal enhancement or calcification in the posterior aspect of this lesion. Given her age and partial calcification, she underwent a CT-guided mediastinum biopsy, and samples were sent for analysis. Pathology showed fibrous cyst wall lined by ciliated cuboidal epithelial cells, suggestive of bronchogenic cyst. On follow-up outpatient, she was referred to thoracic surgery.DISCUSSION: Mediastinal masses are uncommon incidentally. Some of the symptoms seen with these masses arise due to systemic symptoms related to excess hormone release, cytokines, or antibodies, local nerve invasion, or compression of vascular structures, airways, esophagus, and bone. The array of symptoms can guide the diagnosis. CT is the recommended diagnostic modality, however, magnetic resonance imaging (MRI) can help distinguish cystic from solid masses. Laboratory tests including Beta HCG, lactate dehydrogenase (LDH), alpha-fetoprotein, serum IgA, and IgG can also help narrow the differentials. Bronchogenic cysts can either be an incidental discovery or present with sinister complications like superior vena cava syndrome, tracheal compression, pneumothorax, neoplastic conversion, pneumonia, and lung abscess among others. Therefore, it is recommended that even the asymptomatic cysts are discovered and removed early unless the surgical risk is elevated due to increased age and comorbidities. Minimally invasive diagnostic and therapeutic modalities like the recent use of endobronchial ultrasounds (EBUS) with biopsy and transbronchial needle aspiration (TNA) have been gaining popularity over traditional approaches like mediastinoscopy and surgical resection.CONCLUSIONS: Our patient in this case presented with an anterior mediastinal mass, however, it was not due to any of the common causes. This case highlights the importance of keeping bronchogenic cyst as a differential diagnosis in an immunocompetent person with no risk factors or symptoms suggestive of the other common causes.Reference #1: Carter BW, Marom EM, Detterbeck FC. Approaching the Patient with an Anterior Mediastinal Mass: A Guide for Clinicians. Journal of Thoracic Oncology. 2014;9(9):S102-S9.Reference #2: Iyer H, Vadala R, Mohan A, Jain D. A young immunocompetent female with anterior mediastinal mass. Lung India. 2021;38(4):389-93.Reference #3: Rosenblum MK, Wang SX, Seeley EJ. A mass that has no (EBUS) echo. Respir Med Case Rep. 2018;23:18-20.DISCLOSURES: No relevant relationships by Vincent ChanNo relevant relationships by Syeda HassanNo relevant relationships by Chaitra JangaNo relevant relationships by John MadaraNo relevant relationships by Ifrah NaeemNo relevant relationships by Kimberley OkoyezeNo relevant relationships by Nathaniel Rosal SESSION TITLE: Diagnosis of Lung Disease through Pathology Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: 50% of masses occur in the anterior mediastinum and are commonly due to thymoma, teratoma, thyroid disease, and lymphoma. A bronchogenic cyst is a bronchopulmonary congenital malformation that arises from abnormal tracheobronchial tree budding. Its finding may be incidental or due to one of its complications. It is diagnosed via imaging. Surgical excision may be recommended. CASE PRESENTATION: A 64-year-old female with a history of hypertension presented to the emergency room (ER) with complaints of abdominal pain, nausea, and headaches. In the ER, vitals and physical exam were unremarkable. Laboratory findings were significant for sodium of 125 mmol/L, chloride of 87 mmol/L, white cell count of 10.5 B/L, and hemoglobin of 12.3 g/dL. She had a chest X-ray that raised concerns of a widened mediastinum. As a result, CTA chest pulmonary angiography was ordered which showed an anterior mediastinal mass with a minimal enhancement or calcification in the posterior aspect of this lesion. Given her age and partial calcification, she underwent a CT-guided mediastinum biopsy, and samples were sent for analysis. Pathology showed fibrous cyst wall lined by ciliated cuboidal epithelial cells, suggestive of bronchogenic cyst. On follow-up outpatient, she was referred to thoracic surgery. DISCUSSION: Mediastinal masses are uncommon incidentally. Some of the symptoms seen with these masses arise due to systemic symptoms related to excess hormone release, cytokines, or antibodies, local nerve invasion, or compression of vascular structures, airways, esophagus, and bone. The array of symptoms can guide the diagnosis. CT is the recommended diagnostic modality, however, magnetic resonance imaging (MRI) can help distinguish cystic from solid masses. Laboratory tests including Beta HCG, lactate dehydrogenase (LDH), alpha-fetoprotein, serum IgA, and IgG can also help narrow the differentials. Bronchogenic cysts can either be an incidental discovery or present with sinister complications like superior vena cava syndrome, tracheal compression, pneumothorax, neoplastic conversion, pneumonia, and lung abscess among others. Therefore, it is recommended that even the asymptomatic cysts are discovered and removed early unless the surgical risk is elevated due to increased age and comorbidities. Minimally invasive diagnostic and therapeutic modalities like the recent use of endobronchial ultrasounds (EBUS) with biopsy and transbronchial needle aspiration (TNA) have been gaining popularity over traditional approaches like mediastinoscopy and surgical resection. CONCLUSIONS: Our patient in this case presented with an anterior mediastinal mass, however, it was not due to any of the common causes. This case highlights the importance of keeping bronchogenic cyst as a differential diagnosis in an immunocompetent person with no risk factors or symptoms suggestive of the other common causes. Reference #1: Carter BW, Marom EM, Detterbeck FC. Approaching the Patient with an Anterior Mediastinal Mass: A Guide for Clinicians. Journal of Thoracic Oncology. 2014;9(9):S102-S9. Reference #2: Iyer H, Vadala R, Mohan A, Jain D. A young immunocompetent female with anterior mediastinal mass. Lung India. 2021;38(4):389-93. Reference #3: Rosenblum MK, Wang SX, Seeley EJ. A mass that has no (EBUS) echo. Respir Med Case Rep. 2018;23:18-20. DISCLOSURES: No relevant relationships by Vincent Chan No relevant relationships by Syeda Hassan No relevant relationships by Chaitra Janga No relevant relationships by John Madara No relevant relationships by Ifrah Naeem No relevant relationships by Kimberley Okoyeze No relevant relationships by Nathaniel Rosal" @default.
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• W4304092566 date "2022-10-01" @default.
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• W4304092566 title "BRONCHOGENIC CYST PRESENTING AS AN ANTERIOR MEDIASTINAL MASS" @default.
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