Bronchogenic cyst mimicking Croup

Journal review:"A 4-year-old boy presenting with recurrent croup", Chien-Yu Lin, Hsin Chi, Shin-Lin Shih and et al, European Journal of Pediatric (2010) 169:249–251

Author reported a case of 4 years old boy presented to hospital with the chief complaint of fever and barking cough and history of recurrent croup since age 1 year and 8 months old.

History

1. One months ago presented to hospital with fever, barking cough, occasional shortness of breath and prescribed with oral prednisolone (1 mg kg−1day−1)

2. Now presented with fever and barking cough, decrease appetite.

3. PE (decreased breath sound over lower chest)

Investigation in sequale

1. FBC (microcytic anemia, leukocytosis)

2. CXR (Segmental atelectasis over left lower chest and mass shadow over mediastinum.

3. CT Scan (3.5-cm low attenuation cystic lesion in the left parahilar area and emphysematous change of left upper and left lingula lobe)

4. Bronchoscopy (Bronchomalacia with external compression over left main bronchus)

5. Esophagogram (lateral external compression of the mid-third esophagus and no evidence of contrast medium outside of the esophageal lumen)

Diagnosis: Bronchogenic cyst

Management: Surgical excision was done. Pathology report reveals respiratory ciliated epithelial lining which proves diagnosis of Bronchogenic cyst. Patient recovered and develops no more episodes of croup during follow up

Discussion

Croup or laryngotracheitis is very common in children and 95% of it causes by virus.

Most of the time it is due to parainfluenza virus. However, metapneumovirus, RSV and influenza can give similar features.

Patient usually present with severe barking cough, harsh& rasping stridor and hoarse cry. However there is no drooling of saliva and patient is able to drink water which differentiates it from epiglottitis.

Recurrent croup is not common but may be associated with allergy and gastro esophageal reflux.

Bronchogenic cyst is abnormal development of foregut that may located anywhere along trachea-esophageal tract. Symptoms differ from asymptomatic to life threatening depending on patient's age, location and size of cyst. It is usually located at paratracheal region and perihilar area. Although intra abdominal cyst is rare, gastrointestinal symptoms may present. 2/3 of the patients are asymptomatic but airway compression is common in children while infected cyst is common in adults. However, Bronchogenic cyst mimicking croup is rare and seldom reported in literature.

Learning points

1. Croup is not uncommon in pediatric population. Therefore, attention should be paid to atypical presentation and detail history must be taken.

2. Bronchoscopy is recommended for recurrent croup and croup with atypical presentation especially in case of severe croup requiring intubation, minimal response to treatment or in case older than 3 years old.

3. Chest X Ray is not commonly performed in croup.

4. Mediastinal mass may mimic croup in clinical presentation,

5. Bronchogenic cyst is a rare congenital disease, and it may cause airway compression and mimic croup