congenital pulmonary cyst
Introduction
Introduction to congenital pulmonary cyst Congenital pulmonary cyst is a congenital malformation of the lungs, which is not uncommon in children and can also be seen in newborns. Its pathological classification and naming are quite confusing, and the opinions are different. In the past, it was collectively referred to as congenital pulmonary cyst. It is now more commonly called congenital pulmonary cystic disease, including bronchogenic cysts (pulmonary cysts), alveolar-derived cysts, and lungs. Swollen (pulmonary bullae), cystic adenomatoid malformations and congenital cystic bronchiectasis. There is no gender difference in the incidence of this disease. The clinical manifestations of this disease can be very different. Small cysts can be free of any symptoms. They are only found on X-ray examination. Large cysts have symptoms only after secondary infection or swelling and compression of surrounding tissues. The disease should be treated surgically. The effect is good. basic knowledge Sickness ratio: 0.05% Susceptible people: no specific population Mode of infection: non-infectious Complications: blood chest, pneumothorax
Cause
Causes of congenital pulmonary cysts
Congenital dysplasia (95%)
During the embryonic development period, due to the abnormal development of the bud or branch of the trachea and bronchial abnormalities, the lesions may occur in different parts of the bronchial branches and show different developmental stages. The cysts are often multi-atrial, but also single-atrial, cystic wall. It has a small bronchial wall structure, a ciliated columnar epithelium in the inner layer, and a small piece of cartilage scattered in the outer layer. Smooth muscle bundles and fibrous tissue can be seen in the wall. Different dermal cells can be seen in the inner layer of the cystic lesion structure, with columnar, cuboidal and Round epithelial cells, which show varying degrees of incomplete development of bronchial tree branches, some have columnar cells that secrete mucus, and the cavity is filled with mucus.
Prevention
Congenital pulmonary cyst prevention
1. Pre-marital examination mainly includes comprehensive physical examination, genetic health inquiry and common sense explanations after marriage. Among them, genetic counseling and genetic testing are important contents.
2, prenatal diagnosis: prenatal diagnosis only 20 years of history, but rapid development, methods include X-ray, fetal mirror, ultrasound, biochemistry and enzyme examination, chromosome diagnosis, etc., the most commonly used ultrasound and chromosome examination. Through prenatal examination, an accurate judgment is made on whether the embryo or fetus has a hereditary congenital malformation before birth, and a therapeutic abortion is performed on the abnormal fetus to prevent the birth of the defective child, thereby ensuring the health of the offspring.
3, precautions during pregnancy, pregnant women to avoid exposure to radiation, cold stimuli, drugs and other factors that easily lead to congenital diseases, especially in the golden age of lung development in the second trimester, we must pay attention to the protection of pregnant women, prevent fetal abnormalities Form a congenital pulmonary cyst.
Complication
Congenital pulmonary cyst complications Complications
Complications caused by pulmonary cysts include the following:
(1) The lung cyst itself has no gas exchange function. The huge cyst can compress the lung tissue, causing gas exchange disorder in the lungs. In severe cases, the pulmonary artery pressure can be increased, and the burden on the heart is increased.
(2) Long-term repeated infection is likely to cause adhesion of surrounding tissues, affecting lung function, increasing the difficulty of surgery, and affecting postoperative recovery.
(3) Bleeding caused by destruction of the cyst wall of the lung cyst, perforation, causing pneumothorax, hemothorax.
(4) It has been reported in the literature that pulmonary cysts may be malignant.
Symptom
Symptoms of congenital pulmonary cysts Common symptoms purulent purpura hemoptysis chest pain chest shortness breath shortness respiratory failure
Small bronchogenic cysts do not present symptoms in the clinic. They are only found on X-ray chest examinations or autopsy. Once cystic lesions communicate with the small bronchus, secondary infections or tension-induced balloon swelling, fluid cysts, and fluid cysts are caused. Symptoms may occur when the lung tissue is compressed by a tension pneumothorax, the heart, the mediastinum, and the trachea are displaced.
(1) Infant and young children : tension bronchogenic cysts, pulmonary lobe emphysema and pulmonary bullae are more common, clinically often present in the chest tension high pressure symptoms, manifested as shortness of breath, purpura or respiratory distress and other symptoms Physical examination showed that the trachea moved to the contralateral side, the affected side percussion drum sound, the respiratory sound decreased or disappeared, and the chest radiograph showed that the pulmonary cystic lesion of the affected side caused atelectasis, mediastinum, tracheal displacement, and the mediastinal hernia and ipsilateral lung No, the condition is critical, not diagnosed and treated in time, can die due to respiratory failure.
(B) childhood : more common is bronchogenic cysts, clinical manifestations of repeated lung infections, patients often due to fever, cough, chest pain, symptoms similar to bronchial pneumonia.
(C) adult stage : more common in the day after secondary bullous bullous and bronchogenic cysts, clinical manifestations due to secondary infection symptoms, such as fever, cough, purulent sputum, hemoptysis, chest tightness, asthma-like episodes, exhaustion To promote recurrence of pneumothorax and other symptoms, it is necessary to identify with lung abscess, empyema, bronchiectasis, tuberculosis cavity and lung tumor.
Examine
Examination of congenital pulmonary cysts
1, mainly for X-ray examination of the disease, the clinical symptoms are atypical, need to pay attention to differential diagnosis, X-ray chest examination shows a clear circular or elliptical dense shadow, or a circular or elliptical wall with a thin transparent cavity There can be a liquid level in the shadow.
Congenital bronchogenic cysts: common in children, cysts located in the interstitial or mediastinum of the lungs, about 70% in the lungs, 30% in the mediastinum, because the cysts can be single or multiple, containing different amounts of gas or liquid, thus Different performance on X-ray:
1 single fluid, balloon swelling: the most common, cyst size is different, visible round thin-walled cyst, there is a liquid surface, this cyst is characterized by a thin wall of the capsule, adjacent to the lung tissue without inflammatory infiltration lesions, fibrous changes More, need to identify with lung abscess, tuberculosis cavity and lung hydatid cyst, on the X line, the lung abscess wall is thicker, the surrounding inflammation is obvious, the tuberculosis cavity has a longer history, surrounded by tuberculosis satellite, lung hydatid cyst Regional characteristics of epidemiology, life history and occupational history, blood images, and intradermal tests can help identify.
2 single balloon swelling: the chest surface shows the lungs containing the balloon swelling, huge balloon swelling can occupy one side of the chest cavity, oppression of the lungs, trachea, mediastinum, heart, need to be identified with pneumothorax, pneumothorax is characterized by lung atrophy pushed to the hilum The air of the balloon is located in the lungs, and the lung tissue is often observed at the tip of the lung and the ribs.
More than 3 balloon swelling: more common in the clinic, there are multiple balloon swells of different sizes and margins on the chest radiograph, which need to be differentiated from multiple bullae, especially in children, pulmonary bullae often accompanied by pneumonia. The X-ray is characterized by translucent round thin-walled bullae and its size, number, and morphological variability. Every time during short-term follow-up, there are more changes, sometimes it can increase rapidly, or it can form a pneumothorax after rupture, and the lung inflammation Once it has subsided, the bullae sometimes shrinks or disappears on its own.
4 multiple fluids, balloon swelling: a variety of fluids of different sizes can be seen on the chest radiograph, air cavity, especially the lesion on the left side, need to be identified with congenital diaphragmatics, the latter can also be presented as multiple liquid level, if necessary, oral Iodine oil or dilute sputum examination, if the contrast agent is seen in the chest cavity into the gastrointestinal tract, it is a barrier.
2, lung function test, bronchography, CT scan is also conducive to the diagnosis of this disease.
Diagnosis
Diagnosis and diagnosis of congenital pulmonary cyst
diagnosis
(1) Mainly for X-ray examination: the clinical symptoms of this disease are not typical, and it is necessary to pay attention to differential diagnosis. X-ray chest examinations show a densely rounded or elliptical dense shadow, or a flat or elliptical wall with a shallow liquid shade.
(2) Pulmonary function test, bronchography, CT scan is also conducive to the diagnosis of this disease.
Differential diagnosis
The disease is a congenital lung dysplasia, which may be due to the size of the cyst, whether it is connected with the airway such as the bronchus, whether there are secondary infections and different ages of treatment, and various clinical symptoms appear. It is easy to be misdiagnosed as a variety of different diseases. For example, when the cyst is not communicated with the bronchus, the dense shadow of the chest X-ray is easily misdiagnosed as a benign tumor in the lung. When the cyst and the bronchial communication chest have a hollow translucent shadow, it is easily misdiagnosed. For the tuberculosis cavity; cysts have secondary infections, easy to be misdiagnosed as pneumonia or lung abscess, causing delays in correct treatment, so the diagnosis should be strictly diagnosed with the following diseases:
(1) Lung abscess: The clinical manifestations of lung abscess are heavier, such as bacterial lung abscess: acute onset, high fever, more obvious symptoms of poisoning, coughing a lot of purulent, anti-infective treatment effective; amoebic abscess: often history of dysentery, Cough brown red sputum, sputum smear can find amoeba cysts or trophozoites, single lung cyst secondary infection is similar to lung abscess symptoms, but X-ray plain film shows thicker lung abscess wall, peripheral lung tissue infiltration or Fibrosis changes, the lesions may change dynamically after anti-infective treatment, and congenital pulmonary cysts often have no symptoms of systemic poisoning. After infection control, the fluid in the cyst may be empty, while the cyst remains fixed without change. CT is on the lung abscess. The lung texture response was obvious, the wall thickness was uneven, and no lace-like changes were observed in the capsule.
(2) Lung hydatid cysts: The popular areas in China are Xinjiang, Qinghai, Gansu, Ningxia, Inner Mongolia and Tibet. However, due to the developed transportation, population movement, processing of livestock products, and frequent transportation, it is only popular in pastoral areas. Hydatidosis can also be infected by indirect contact in towns in non-endemic areas. Clinical manifestations: Pulmonary hydatid cyst is an expanding space-occupying lesion. The hydatid cyst is multiplied in years and the wall is thinner and smaller. Cysts generally do not cause symptoms. When they grow up to a certain extent, they may have chest pain, cough, fever and other symptoms when they have oppression or secondary infection. Pulmonary hydatid is spread by blood, lower leaves are more than upper leaves, right leaves More than the left lobe, X-slice and CT showed a liquid level in the cyst, and two layers of curved translucent shadow were visible above it; if only the inner capsule ruptured and part of the capsule floated on the cyst fluid, it showed "water floating lotus sign".
(3) Pneumonia (especially Staphylococcus aureus pneumonia): The clinical manifestations of congenital pulmonary cysts are similar to those of pneumonia. However, congenital pulmonary cysts often have no obvious systemic symptoms and are recurrent. The lesions are at the fixed site. Patchy shadows are accompanied by thin-walled circular translucent areas, and patients do not have immunocompromised or other causes of recurrent respiratory infections. Careful observation during the reading and treatment can be distinguished from pneumonia.
(4) Cavity tuberculosis: Cavity tuberculosis is generally small, satellite lesions are visible around, and there are disseminated lesions, which can be distinguished by tuberculin test and tuberculosis antigen and antibody detection and X-ray film follow-up.
(5) Pulmonary vesicles combined with infection: Pulmonary vesicles often have morphological changes, which may appear or disappear in a short period of time, while congenital pulmonary cysts persist for a long time, and the sites are fixed. The lung vesicles are infected with fluid and the surface is flat. , the diameter is small.
(6) Pneumothorax: Tension-induced pulmonary air sacs should be differentiated from pneumothorax. Pulmonary cysts are located in the lung parenchyma. Gastric lung tissue is visible in the lung tip, lung base and rib angle, while the gas in the pneumothorax is located in the pleural cavity. The lung tissue is pushed to the hilar, and the chest radio helps to distinguish.
(7) Congenital spasm: Occasionally on the left side, clinically, respiratory distress is the main manifestation, and barium angiography helps to differentiate from multiple pulmonary cysts.
(8) Lung cancer: The age of onset is large. The density of spherical lesions on CT is higher than that of cysts, and there are often lobes and short burrs on the edges.
