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Questions and Answers
What is a bronchogenic cyst?
What is a bronchogenic cyst?
Where are bronchogenic cysts most commonly found?
Where are bronchogenic cysts most commonly found?
A newborn presented with acute respiratory distress, what was discovered during the examination?
A newborn presented with acute respiratory distress, what was discovered during the examination?
What did the cytological analysis of the fluid from the fine needle aspiration of the cyst show?
What did the cytological analysis of the fluid from the fine needle aspiration of the cyst show?
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What was the primary surgical approach employed to address the cervical bronchogenic cyst in the newborn?
What was the primary surgical approach employed to address the cervical bronchogenic cyst in the newborn?
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Which of the following procedures was performed to help the newborn breathe after the surgery?
Which of the following procedures was performed to help the newborn breathe after the surgery?
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What was the size of the bronchogenic cyst that was surgically removed from the newborn?
What was the size of the bronchogenic cyst that was surgically removed from the newborn?
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What was one of the complications identified during follow-up after the discharge from hospital?
What was one of the complications identified during follow-up after the discharge from hospital?
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What surgical procedure may be indicated for fetal airway obstruction caused by a neck mass?
What surgical procedure may be indicated for fetal airway obstruction caused by a neck mass?
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What role does a videolaryngoscope play in neonatal care post-surgery?
What role does a videolaryngoscope play in neonatal care post-surgery?
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What is the consequence of laryngeal nerve injury after surgery in newborns?
What is the consequence of laryngeal nerve injury after surgery in newborns?
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What is a potential cause of polyhydramnios detectable during prenatal ultrasound?
What is a potential cause of polyhydramnios detectable during prenatal ultrasound?
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Which diagnostic method is most beneficial in mapping anatomical relationships before surgery in this context?
Which diagnostic method is most beneficial in mapping anatomical relationships before surgery in this context?
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Study Notes
Bronchogenic Cysts in Newborns
- Bronchogenic cysts are congenital malformations of the tracheobronchial tree, typically found in the mediastinum or lung, occasionally in the neck.
- These cysts can present as a neck mass with chronic cough or stridor, sometimes not diagnosed until adulthood.
- A rare case involved a newborn experiencing acute respiratory distress due to a cervical bronchogenic cyst, along with ineffective ventilation and needing positive pressure ventilation.
- Prenatal ultrasounds showed normal development in the mother.
- The newborn's abnormal fetal heart rate led to induced delivery at 41+4 weeks.
- Left cervical swelling, respiratory distress, and stridor were observed.
- Intubation attempts were initially unsuccessful, becoming successful only after a third attempt with sedation.
- Imaging revealed a large cystic mass impacting the aerodigestive tract, requiring high peak inspiratory pressures for ventilation.
- Fine-needle aspiration (day 3) yielded clear fluid with respiratory and squamous epithelium.
- Rigid bronchoscopy confirmed tracheal compression, but no laryngeal fistula.
- A cervical approach surgery (day 5) revealed a unilocular cyst (25x23x6mm) attached to the trachea and esophagus requiring limited resection.
- Histology confirmed the diagnosis as a bronchogenic cyst.
- Re-intubation efforts were impacted by laryngotracheal edema and left vocal fold paresis, necessitating a tracheostomy (day 13).
- Mechanical ventilation ceased two weeks post-surgery.
- Subglottic stenosis appeared on day 33, with subsequent balloon dilation, while proximal esophageal stenosis was noted but untreated.
- Two months post-surgery, breastfeeding was successful, and airway stenosis resolution allowed the tracheostomy tube removal.
- Prenatal ultrasound may identify cervical masses as bronchogenic cysts; potentially causing polyhydramnios.
- Cesarean section may be required for abnormal fetal heart rates.
- Tracheal compression caused respiratory distress in the patient, also impacting intubation due to unseen larynx.
- Videolaryngoscopes enhance visibility of the upper airway.
- Rigid bronchoscopy or rigid flexometallic tubes manage glottic-subglottic issues, but caution is necessary.
- EXIT procedure (ex utero intrapartum treatment) may be relevant for fetal airway obstructions caused by neck masses, especially in cases of cervical lymphatic malformations or teratomas.
- Differential diagnoses include cystic hygroma, thymic cyst, branchial cyst, and thyroglossal duct cyst, needing histological examination for verification.
- MRI aids in anatomical mapping prior to surgery, while rigid bronchoscopy assesses cyst-trachea contact.
- Needle aspiration has limited use, with surgical excision as the primary treatment, due to infection and hemorrhage risks.
- Left vocal cord paralysis is a potential post-surgical complication from laryngeal nerve injury, exacerbated by intubation, surgical inflammation, and prolonged ventilation.
Differential Diagnoses
- Cystic hygroma
- Thymic cyst
- Branchial cyst
- Thyroglossal duct cyst
Treatment
- Surgical excision
- Fine-needle aspiration (limited utility)
- Tracheostomy
- Balloon dilation for subglottic stenosis
Complications
- Tracheal compression
- Respiratory distress
- Intubation difficulties
- Laryngotracheal edema
- Left vocal cord paralysis
- Esophageal stenosis
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Description
Explore the complex case of bronchogenic cysts in newborns, including their presentation, diagnosis, and management. This quiz delves into a specific case involving respiratory distress and imaging findings, highlighting clinical protocols and outcomes. Test your knowledge on congenital malformations and their implications.
