Abstract Introduction Bronchogenic cysts are rare congenital foregut malformations, usually asymptomatic and often discovered incidentally. Hemorrhagic bronchogenic cysts are even rarer, with few cases reported. Their presentation is variable and can mimic abdominal, thoracic, or musculoskeletal conditions, making diagnosis challenging. Description: A 21-year-old female with a past medical history of polycystic ovary syndrome presented with left-sided abdominal pain radiating to the back and left lower extremity. Physical examination and initial laboratory studies- renal and hepatic function panels, complete blood count, infectious workup, inflammatory markers, lipase, and pregnancy test, were unremarkable. CT of the abdomen and pelvis revealed a left paravertebral ovoid mass centered at the T10 level. Further evaluation with MRI demonstrated a 5.2 × 3.5 × 2.0 cm left paraspinal mass at the T10-T11 levels without intraspinal extension. The initial differential diagnosis included neurogenic lesions such as a nerve sheath tumor, and was supposed to be scheduled for an outpatient biopsy and follow-up. However, the patient subsequently developed worsening pain in the left mid-back region, prompting repeat imaging. Repeat CT showed an increase in size of the left paraspinal mass, along with a new left pleural effusion, raising concern for a pleural-based lesion. Cardiothoracic surgery was consulted and given the patient’s persistent symptoms, decision was made to proceed with robot-assisted mediastinal mass resection. Intraoperatively, murky purulent pleural fluid was aspirated and sent for culture. The lesion, located in the inferior thoracic cavity, appeared clot-like with a stalk-like structure at its base, which was clipped. All debris and blood were evacuated, and the specimen was sent for histopathologic analysis. Frozen section was inconclusive for malignancy or infection. Final pathology confirmed a hemorrhagic bronchogenic cyst. All infectious studies were negative. The patient’s symptoms improved postoperatively, and she was discharged home in stable condition. Discussion Hemorrhagic bronchogenic cysts are difficult to diagnose due to nonspecific symptoms and rare presentation. In this case, abdominal and back pain initially suggested common etiologies, but imaging revealed a hemorrhagic paraspinal mass. This highlights the need for a broad differential and avoidance of bias, particularly in young women whose symptoms may be underestimated. Thorough evaluation with imaging and timely surgical consultation is essential, as early recognition and intervention improve outcomes. This abstract is funded by: None
Garcia et al. (Fri,) studied this question.