CT reorganization manifestations of congenital bronchopulmonary cysts

Congenital bronchopulmonary cysts are a congenital disease caused by disorders of the trachea, bronchial tree, or lung buds during embryonic development, and are the most common congenital lesion of the respiratory system. Cysts can be single or multiple, and most of them are reported to be multiple in the literature, whereas 13 out of 15 cases in our hospital were single and were more frequent in the right lung than in the left lung. Cysts occurring in the large airways of the mediastinum are called mediastinal bronchial cysts, also known as central pulmonary cysts; cysts occurring in the small bronchioles within the lungs are called pulmonary cysts, also known as peripheral pulmonary cysts. The inner layer of the cyst is epithelial with cilia and columnar epithelium, and there are bronchial tissues such as smooth muscle, mucous glands, cartilage and elastic fibers. When the cyst is not connected with the bronchus, the secretion inside the cyst can not be discharged, the cyst gradually accumulates and expands, forming a fluid-containing cyst; once the cyst is connected with the bronchus, the fluid inside the cyst is completely discharged and it becomes an air-containing cyst; if there is no smooth communication between the cyst and the bronchus or the air-containing cyst is formed with the formation of air-containing fluid cysts as a result of secondary infection. In this paper, there were 5 cysts of different sizes in the right lung, including 3 air-containing cysts and 2 air-liquid cysts, and the wall of air-liquid cysts was thicker. The contents of fluid-containing cysts may have uneven density due to repeated infections, hemorrhage, increased protein content, and calcification, and the CT value varies from high to low, usually around 0-20 HU and up to 80.5 HU, which is sometimes easy to be misdiagnosed as a substantial tumor. Repeated infections of cysts lead to peripheral fibrosis, thickening of cyst wall, and solid changes should be noted to distinguish from chronic lung abscess; those occurring in the posterior basal segment of the lower lobe should be distinguished from pulmonary isolation. MPR is a reorganization of the original axial image in coronal, sagittal, oblique and arbitrary levels, which can truly display the internal structure of organs and tissues, the location, morphology, size, density and relationship with the surrounding of the lesion. It can accurately show the relationship between peripheral pulmonary cysts and bronchial tubes; it can clearly show the relationship between central pulmonary cysts and large blood vessels in the mediastinum, heart and esophagus. In this group, one case of mediastinal fluid-containing cyst showed compression of the right atrium and ascending aorta, and well showed the relationship between the lesion in the mediastinum and the lesion in the lungs, and realistically showed the intrinsic connection between the large fluid-containing cysts in the mediastinum and the small air-fluid cysts in the lungs. Air-containing fluid lesions in both lower lungs need to be discharged from pulmonary isolation, and MPR reorganization can clarify whether there is a vascular connection between the lesion and the thoracic aorta, thus confirming the diagnosis or discharging pulmonary isolation. It provides assistance in formulating a surgical plan. The SSD surface reconstruction of the bronchus and lungs is based on the lowest density projection method, which distinguishes air-containing tissues and organs from the surrounding soft tissues, so only air-containing trachea and lungs can be reconstructed. The SSD of one case in this group not only showed the cyst well, but also showed that the cyst’s relationship with the bronchus was like a “withered fruit”. Therefore, the air-containing cyst was well visualized. Fluid-containing cysts cannot be reorganized by the SSD method. Air-containing fluid cysts can be reorganized into air-containing portions by the SSD method, and the morphology varies depending on the amount of air contained. The bronchial and lung SSD surface reconstruction methods are only useful for gas-containing cysts or partial gas-containing fluid cysts. Fluid-containing cysts and air-containing cysts require MPR reorganization to be visualized well and completely, especially MPR sagittal reorganization, which can be used to visualize air-containing cysts in their entirety. Air-containing cysts can likewise be clearly visualized with the MPR method. Our experience is that SSD and MPR reorganization of the bronchus and lungs have their own advantages, but MPR is practical for the display of various cysts and is more realistic, which is the best reorganization method for congenital bronchopulmonary cysts. SSD reorganization method has a strong sense of spatial three-dimensional, clear surface anatomical relationship, which is conducive to the localization of the lesion, although it can also give a real, intuitive feeling. However, the disadvantage is affected by the selection of the threshold, the threshold is too high, easy to cause the illusion of lumen narrowing; the threshold is too low, the edge of the fuzzy. The joint application of axial position, SSD, and MPR should be advocated in clinical work, especially for patients who need to be operated, it is necessary to carry out MPR and SSD reorganization before operation.