Evaluation and diagnosis of bronchogenic cyst

During pregnancy, ultrasound surveillance is used to monitor size and growth of the bronchogenic cyst. Occasionally, MRI may be used in addition to ultrasound imaging. If you are referred to the Center for Fetal Diagnosis and Treatment at Children’s Hospital of Philadelphia (CHOP), you will have a comprehensive one-day evaluation.

Because several types of lung lesions look similar on prenatal imaging, the diagnosis may not be confirmed until the cyst is removed and examined after birth.

Determining severity of bronchogenic cyst before delivery

Severity is determined by the size, location, and whether the bronchogenic cyst is pressing on nearby structures. Small cysts usually do not cause any symptoms. Larger cysts or cysts located near the airway, esophagus or heart, may affect the baby’s breathing or swallowing after birth, or put pressure on their heart. In rare cases, pressure on the esophagus can lead to a buildup of amniotic fluid, called polyhydramnios.

Your care team will use ultrasound and, when needed, MRI to look for these effects and plan the safest care for your baby. 

Management of pregnancy complicated by bronchogenic cyst

Your care team will monitor the cyst with ultrasound during pregnancy. The frequency of these ultrasounds will depend on the size (of the cyst), location and effect on nearby structures. In rare cases, a large cyst causing serious complications may be drained with a needle procedure in utero.

Delivery of babies with bronchogenic cyst

If the bronchogenic cyst is small, routine delivery at or near term with your home provider may be possible.

Sometimes very small cysts may not be visible on ultrasound towards the end of pregnancy, or even at birth. However, this does not mean that the cyst has disappeared. After your baby is born, it is important to schedule a follow-up appointment with the fetal surgeon who counseled you during pregnancy.

If the cyst is large and/or causing problems with other vital organs, delivery in the Garbose Family Special Delivery Unit (SDU) may be recommended. Your care team will develop a delivery plan based on your baby’s individual needs.

Rarely, an EXIT procedure may be required to deliver the baby. In an EXIT procedure, our SDU team will partially deliver the baby so that they are still attached to the placenta and receiving oxygen through the umbilical cord. This procedure allows time for fetal surgeons to establish an airway and remove the bronchogenic cyst. After the cyst is removed and your baby can breathe on their own, they will be fully delivered.

Your team will include a nurse coordinator, a maternal-fetal medicine specialist, and a pediatric and fetal surgeon. We will work with you to develop a treatment plan that is best for you and your family and is safe for the newborn.

Treatment for bronchogenic cyst

If the bronchogenic cyst is small and the baby is asymptomatic at birth, routine care is advised, including a CT scan at 1-2 months of age, with surgical resection of the cyst to follow. Surgical resection is generally recommended to avoid infection or pressure on nearby structures if it grows to be very large. 

Removal also eliminates the extremely rare possibility of the cyst becoming cancerous later in life.

If the baby is symptomatic at birth, a chest X-ray and CT scan may be necessary as soon as possible, with surgical resection of the cyst sooner rather than later.

Long-term outlook

The vast majority of children with congenital lung lesions, including bronchogenic cyst, do extremely well and have normal lung function after their lesions are removed. No long-term follow up is required in these cases.

Children with moderate to large lesions can also do extremely well, but their outlook depends on expert treatment to avoid potential complications. These children may require long term follow-up and in rare cases support through our Pulmonary Hypoplasia Program (PHP).