Bronchogenic Cyst with Extrinsic Pulmonary Vein and Left Atrial Compression Presenting as Exertional Dyspnea

A previously healthy 52-year-old male presented with a several week history of progressive exertional dyspnea. Physical examination and electrocardiogram were unremarkable. A transthoracic echocardiogram (TTE) was performed (Fig. 1). Initially it was thought that a membrane was within a large left atrium (LA). To further delineate the LA and its anatomy, peripheral injection of sonicated contrast (Optison, Amersham Health, Inc., Princeton, NJ) was performed (Fig. 2). A “contrast-free” cystic appearing structure became readily apparent. Computed tomography (CT) of the chest likewise demonstrated a cystic structure adjacent to the LA (Fig. 3). Transesophageal echocardiography (TEE) was then performed. In addition to the cystic mass (Fig. 4), the flow velocity profile in the left upper pulmonary vein (LUPV) was consistent with extrinsic pulmonary vein compression (Fig. 5). The patient subsequently underwent surgical resection of the mass, and had an uneventful recovery. The chief complaint of progressive exertional dyspnea resolved. Histopathology identified ciliated stratified epithelium, consistent with a bronchogenic cyst. A bronchogenic cyst is a congenital lesion that is a remnant from abnormal budding of the embryonic foregut. These cysts are usually single,