Bronchogenic mediastinal cyst associated with congenital heart disease in an infant: Case report

Gallegos R.; Ramos A.; Pérez W.; López J.; Anconeyra M.; Huaman R. · Journal of Pediatric Surgery Case Reports (2026) · DOI: 10.1016/j.epsc.2026.103316

Resumen

Introduction Bronchogenic cysts are rare congenital malformations that may remain asymptomatic or cause respiratory compromise depending on their size and location. Their association with congenital heart disease poses additional diagnostic and therapeutic challenges. Case presentation We report the case of a patient in her second pregnancy, whose prenatal care revealed congenital heart disease. She was delivered by elective cesarean section at a cardiology hospital. Her birth weight was 3454 g. She presented with postpartum depression and respiratory distress requiring hospitalization. An echocardiogram performed during hospitalization revealed an ostium secundum atrial septal defect, mild tricuspid regurgitation, right heart chamber dilation, mild pulmonary valve stenosis, and mild pulmonary hypertension. At four months of age, a CT scan revealed a 25 × 17 mm subcarinal cystic mass causing mild compression of the right bronchus. During her follow-up, she experienced poor weight gain of multifactorial etiology. At a clinical meeting, it was determined that the heart condition should be managed first before surgery for the cyst. However, at a subsequent meeting at seven months, it was determined that the heart condition did not contraindicate surgery for the bronchogenic cyst. The decision was made to wait for weight gain and the absence of lower respiratory infection before proceeding with elective surgery. Due to the lack of weight gain and persistent recurrent pneumonia, a second CT scan was performed at 15 months (11 months after the first scan), revealing cyst growth. At 1 year and 7 months, the patient was referred to a center with greater expertise. Upon arrival at our hospital, hospitalization was initiated, along with nutritional management, treatment for the infection, and a multidisciplinary evaluation involving pediatric cardiology, pediatric pulmonology, and infectious diseases. The patient underwent surgery one month after arrival at our hospital (1 year and 8 months). The cyst was excised via a right posterolateral thoracotomy. The patient was transferred to the pediatric intensive care unit post-surgery and had a favorable recovery. Discharge occurred on the fifth post-operative day. At the post-operative follow-up, the patient's pulmonology evaluation was normal, and the patient continued on cardiology medication (spironolactone and furosemide). Closure of the septal defect via catheterization was scheduled to be performed at the referring hospital. Patient up to 6 months of follow-up: weight gain, absence of new respiratory symptoms, physical activity without distress, surgical wound healed. Conclusion Early surgical management of bronchogenic cysts is recommended in symptomatic patients, even in the presence of congenital heart disease, as it allows definitive treatment and prevents complications.