Bronchogenic cysts are congenital malformations of the tracheobronchial tree, generally found in the mediastinum or lung parenchyma, and occasionally in the neck. A report by Mehta... Bronchogenic cysts are congenital malformations of the tracheobronchial tree, generally found in the mediastinum or lung parenchyma, and occasionally in the neck. A report by Mehta et al. in 2004 described four cases of cervical bronchogenic cysts, while Teissier et al. reported eight cases in 2008. Symptoms can vary, often presenting as a neck mass accompanied by chronic cough or stridor; some are not diagnosed until adulthood. This report presents a rare case where a cervical bronchogenic cyst was revealed by acute respiratory distress in a newborn. The infant's mother had regular prenatal care, with normal development observed in antenatal ultrasounds. Induced at 41+4 weeks due to abnormal fetal heart rates, the newborn exhibited ineffective ventilation from birth and required positive pressure ventilation. A left cervical swelling was noted, alongside respiratory distress and stridor. Two failed intubation attempts were followed by successful intubation at the third attempt after sedation. Upon transfer to a specialized neonatal unit, examinations revealed a noninflammatory cervical mass displacing the trachea and surrounding structures. Imaging studies confirmed the presence of a large cystic mass affecting the aerodigestive tract, necessitating high peak inspiratory pressures for adequate ventilation in the initial 48 hours. On postnatal day 3, we performed fine needle aspiration of a cyst under general anesthesia, removing 20 milliliters of clear fluid for cytological analysis, which showed respiratory and squamous epithelium. Rigid bronchoscopy confirmed tracheal compression without a laryngeal fistula. A 3-mm endotracheal tube was placed for airway security. On day 5, a cervical approach surgery revealed a unilocular cystic structure (25 × 23 × 6 mm), closely associated with the trachea and esophagus. Due to the close contact, limited resection of both structures was necessary, subsequently sutured. Histology indicated the cyst was a bronchogenic cyst due to its fibrous tissue and respiratory-type ciliated cell lining. Post-surgery extubation attempts were unsuccessful due to laryngotracheal edema and left vocal fold paresis. A tracheostomy was performed at 13 days old after exploration revealed significant edema and necrosis. Sedation was reduced over 48 hours, and mechanical ventilation concluded two weeks later. Day 33 showed subglottic stenosis treated with balloon dilation, while a proximal esophageal stenosis was noted but untreated. Two months post-surgery, the infant had no airway stenosis, leading to the cannula's removal and successful breastfeeding. Overall growth was satisfactory despite the esophageal stenosis. During prenatal ultrasound, a cervical mass was found to be a bronchogenic cyst, which can potentially lead to polyhydramnios due to esophageal compression. In a similar case, an abnormal fetal heart rate necessitated delivery via cesarean section. Determining the malformation's direct and indirect effects on fetal monitoring poses challenges. The neonatal respiratory distress in our case stemmed from tracheal compression, complicating intubation due to a non-visible larynx. Using a videolaryngoscope improves upper airway visibility, aiding laryngeal access. Rigid bronchoscopy or a flexometallic tube can manage glottic-subglottic compression but requires caution. In cases indicating fetal airway obstruction from a neck mass, the ex utero intrapartum treatment (EXIT) procedure may be applicable, particularly for cervical lymphatic malformations and teratomas. Differential diagnoses include cystic hygroma, thymic cyst, branchial cyst, and thyroglossal duct cyst, though only appropriate histological examination can confirm cyst diagnosis. MRI helps map anatomical relationships before surgery, while rigid bronchoscopy evaluates cyst-trachea contact. Needle aspiration generally offers low value, and surgical excision remains the sole treatment due to infection and hemorrhage risks. Post-surgery, left vocal cord paralysis may arise from laryngeal nerve injury, further complicated by intubation, surgery-related inflammation, and prolonged ventilation in newborns. Bronchogenic cysts are rare congenital abnormalities that occur in the area of the tracheobronchial tree or the lungs. Read more