CHEST Guidelines-A-44-Year-Old-Man-With-Nonproductive-Cough-and-Sen

A-44-Year-Old-Man-With-Nonproductive-Cough-and-Sen

Pdf Summary

A 44-year-old man presented with a nonproductive cough and a sensation of heaviness in his upper chest that had been persistent for seven months. Clinical examinations, blood tests, and imaging initially revealed no significant abnormalities. However, a chest radiograph and a CT scan indicated a right paratracheal mass affecting the superior vena cava (SVC).<br /><br />An endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was performed, revealing an anechoic structure identified as a bronchogenic cyst. The cyst's puncturing led to the aspiration of 35 mL of clear fluid, resulting in the resolution of the patient’s symptoms. Post-procedure imaging confirmed a decrease in the mass's size and dilation of the SVC, validating the diagnosis.<br /><br />Bronchogenic cysts are congenital anomalies derived from the abnormal development of the tracheobronchial tree, potentially leading to compressive symptoms or infections in childhood or adulthood, though many remain asymptomatic and undiscovered until imaging for unrelated reasons. Although surgical excision remains the definitive treatment due to the risk of serious complications, EBUS-TBNA offers a minimally invasive alternative for symptomatic relief and diagnostic confirmation, as evidenced by this case.<br /><br />The procedure demonstrated that careful needle aspiration allows for symptomatic relief and cyst size reduction with minimal complications. However, completeness of the drainage can be uncertain due to potential complex features within the cyst. Consequently, ongoing monitoring or eventual surgery might be recommended, though the patient in this case declined further invasive treatment. The cyst's characterization through imaging and the cyst's aspirated nature on EBUS helped ascertain its noninfective state, guiding appropriate management and antibiotic prophylaxis.

Keywords

bronchogenic cyst

EBUS-TBNA

chest radiograph

superior vena cava

needle aspiration

congenital anomalies

tracheobronchial tree

symptomatic relief

minimally invasive

diagnostic confirmation