Massive enlargement of a previously unrecognized bronchogenic cyst over 8 years with intracystic hemorrhage and complex surgical resection: a case report

Bronchogenic cysts are usually asymptomatic and are often detected incidentally; however, they may become symptomatic due to infection, hemorrhage, or enlargement. We report a case of a previously unrecognized bronchogenic cyst that showed substantial enlargement from 4.8 to 13 cm over an 8-year interval, with intracystic hemorrhage, ultimately requiring partial resection of the esophageal muscularis. A man in his 20s presented with upper abdominal pain and nausea. Computed tomography revealed a 13-cm mass extending from below the tracheal bifurcation to the level of the gastric cardia. A CT scan obtained eight years earlier during the evaluation of abdominal pain had shown a 4.8-cm cystic lesion below the tracheal bifurcation, demonstrating substantial enlargement over the intervening period. Although conservative treatment was attempted, compressive symptoms persisted; therefore, surgical resection was performed for definitive diagnosis and symptom relief. Severe inflammatory adhesions necessitated right open thoracotomy with partial resection of the esophageal muscularis. The cyst contained a large hematoma, and histopathological examination confirmed the diagnosis of a bronchogenic cyst with intracystic hemorrhage. This case demonstrates substantial enlargement of a previously unrecognized bronchogenic cyst from 4.8 to 13 cm over an 8-year interval, with intracystic hemorrhage, symptomatic progression, and technically demanding surgical resection. The potential for substantial enlargement and increasing surgical complexity should be considered when determining the timing of resection for bronchogenic cysts.