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Bronchogenic cysts are congenital malformations thought to develop from abnormal budding of the tracheobronchial tree (1). In normal development, the tracheal bud arises from the embryonic foregut around the fourth week of gestation, and undergoes further branching. If abnormal budding occurs during this process, a blind-ended pouch lined with pseudostratified columnar respiratory epithelial cells develops and forms a bronchogenic cyst. The location of a bronchogenic cyst depends on when the abnormal budding occurred. The cysts are most commonly seen in the mediastinum, especially in the middle and the posterior mediastinum, and can be located in lung parenchyma. The attenuation value is dependent on the contents of the cyst. Although the name is bronchogenic ‘cyst’, the attenuation value can be more than 100 HU if the cyst contains a large amount of protein or calcium. Due to variability in location and internal density, it is often difficult to diagnose bronchogenic cysts on CT scan. With this background, Cardinale et al. (2) proposed diagnostic criteria based on those two factors, the location and the CT density of the lesion. According to these criteria, if the mass was located in a typical location (the middle mediastinum) and showed typical attenuation (fluid attenuation, 0-20 HU), a diagnosis of bronchogenic cyst was considered. However, if the mass was located in an atypical location for bronchogenic cysts and showed soft-tissue attenuation, other diagnoses were considered. In our study, we encountered 3 cases of anterior mediastinal well-circumscribed masses with soft-tissue attenuation. Because of their location and attenuation characteristics these lesions were diagnosed as thymoma preoperatively. However, they were later identified to be bronchogenic cysts on histopathology. As mentioned above, anterior mediastinal bronchogenic cysts are extremely rare. Furthermore, there have been a Case Report pISSN 1738-2637 J Korean Soc Radiol 2012;66(4):347-351

Anterior Mediastinal Bronchogenic Cysts Manifesting as a Solid Mass: A Report of Three Cases