Xueying Ma1, Dun Ding1, Fengli Liang1, Zhuonan Wang1, Haining Li1, Yingxiang Sun1, and Ming Zhang1
1Imaging Medical, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
Synopsis
The purpose of this study
was to provide a deeper knowledge of clinical presentation, imaging diagnosis,
differential diagnosis and the management of the intraspinal bronchiogenic cysts.
We retrospectively studied three cases of SBCs which were registered in our
department and analyzed eight case reports which were all published in English.
The SBCs can occur anywhere in the spinal canal, but they are more likely to
present at the cervical canal and might be along with some developmental
malformations of spine. We emphasize the role of MRI findings in the diagnosis
before surgery. It is recommended that the lesion should be removed as
completely as possible on the premise of protecting the spinal cord from being
injured.
Purpose
Spinal bronchogenic cysts (SBCs) are rare
congenital lesions which are lined with pseudostratified ciliated columnar
epithelium 1. The clinical and imaging characteristics and treatment
of SBCs are not well known. It is difficult to make a right diagnosis before surgery due to its
extremely low morbidity and non-typical symptoms, signs and imaging findings
Advances in MRI have led to an increased understanding of SBCs, although such
cysts may be often misdiagnosed as arachnoid and epidermoid cysts 2.
We studied three cases of SBCs retrospectively, which were registered in our
department and
analyzed eight case reports which were all published in English,
focusing on providing a deeper knowledge of SBCs.Methods
Three patients with SBCs
registered in our department were retrospectively reviewed. Eight reported SBCs
cases published from 1992 to 2015 were enrolled in our study. Imaging diagnosis
was confirmed by MRI, CT, and computed tomography angiography (CTA). The
detailed MRI characteristics such as location, shape, size, margin, signal
intensity were analyzed. All of our patients and reviewed cases had undergone surgical
resection and the final diagnosis was made by pathological examination.Results
Five lesions were located
at the cervical spinal canal, while a thoracic location occurred in three
patients. Two cysts were located at lumbar and sacral spinal canal. One lesion
was stretching to extraspinal space through the intervertebral foramen. Most patients
presented with pain in the limbs and back. Six cysts presented with homogenous
hyperintense on the T2WI and hypointense on T1WI, and only one case showed
heterogeneous hyperintense on T2WI and hypointensity on T1WI. Two cases had
lipomatous tissue adhered to the caudal end of the cystic mass which presented
with high signal on both T1WI and T2WI. Seven lesions were partially removed because
of the adhesions to the nearby spinal cord. All reported cases had no
recurrence in the later follow-up.Discussion
Although the SBCs were
rare, it should not be ignored by radiologists. It can occur anywhere in the
spinal canal, but they are more likely to present at the cervical canal and
might be present along with some developmental malformations of the spine. The
signal intensity on MRI was correlated with cystic fluid traits to a large
extent. Some lipomatous signal was observed in two cases 3. Whether
the sign is specific for SBCs, it may need more literature reviews and studies.
Some research established that the complete excision of the wall by aspiration
and ideal marsupialization were closely associated with a favorable prognosis 4.Conclusions
We emphasize the role of
MRI findings in the disease diagnosis before surgery.Acknowledgements
Xueying Ma and Dun Ding drafted the manuscript. Xueying Ma, Dun Ding and other authors were responsible for collecting the cases.References
1. Rao GP, Bhaskar G, Reddy PK.
Cervical intradural extramedullary bronchiogenic cyst. Neurology India1999. p.
79-81.
2. Wang MY, Levi AD, Green BA.
Intradural spinal arachnoid cysts in adults. Surg Neurol 2003;60(1):49-55;
discussion -6.
3. Baumann CR, Konu D, Glatzel M,
Siegel AM. Thoracolumbar intradural extramedullary bronchiogenic cyst. Acta
Neurochir (Wien) 2005;147(3):317-9; discussion 9.
4. Tucker A, Miyake H, Tsuji M, Ukita
T, Ito S, Matsuda N, et al. Neurenteric cyst of the lower clivus. Neurosurgery
2010;66(1):E224-5.