CTICasesInfected Bronchogenic Cyst and Esophageal Perforation Post-Biopsy
Imaging findings
Initial CT demonstrates a well-circumscribed, homogeneous, high-attenuation subcarinal mass measuring approximately 45 to 50 Hounsfield units. Follow-up chest radiographs and CT scans obtained several days after an endoscopic transesophageal biopsy show a rapid increase in the size of the mass, the development of a large air-fluid level, and a new right-sided pleural effusion, consistent with an esophageal perforation and secondary infection of the cyst.
Key takeaways
Bronchogenic cysts often contain proteinaceous fluid or mucus that can result in unexpectedly high CT attenuation values, mimicking solid mediastinal masses. Transesophageal needle biopsy of these lesions should be approached with caution, as it can introduce oral flora, resulting in a severe, potentially life-threatening infection of the cyst and esophageal perforation requiring urgent surgical debridement or stenting.
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