Tracheal compression secondary to a bronchogenic cyst in an 18-year-old male: a case report

Asthma is the most common pediatric respiratory disease; however, misdiagnosis is steadily increasing. Identification of surgically managed conditions with similar symptoms is essential to ensuring timely management. An 18-year-old healthy male was diagnosed with asthma after visits to the pediatrician and Emergency Department for cough and shortness of breath. For several weeks, he was prescribed antibiotics, prednisone, albuterol, and fluticasone without improvement. He acutely worsened and presented with respiratory distress attributed to status asthmaticus. He required emergent intubation, which was difficult given resistance when advancing the endotracheal tube (ETT). Cross-sectional imaging with computed tomography demonstrated a large superior mediastinal cystic mass with tracheal compression distal to the ETT. After transfer to our facility, he acutely decompensated with worsening ventilatory needs and hypotension requiring vasopressors. After a multidisciplinary discussion, he was brought to the operating room for aspiration of the mass and rigid bronchoscopy. Ultrasound-guided percutaneous drainage of the mass was achieved with immediate improvement in his tidal volumes and evidence of alleviated obstruction on bronchoscopy. He was weaned from respiratory support and extubated postoperatively. A drain contrast study demonstrated no connection to the esophagus or trachea and showed tracheal compression with instillation of contrast into the cavity. Ultimately, he underwent definitive resection of the mass and has had excellent functional recovery. Pathology confirmed a congenital bronchogenic cyst. Bronchogenic cysts can cause airway compression, which may present as new asthma-like symptoms. They can even cause acute airway obstruction. Bronchogenic cysts should be promptly ruled out in patients who develop new asthma-like symptoms but fail to respond to standard treatments.