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Congenital Lung Cysts in Infants and Children

1935; Radiological Society of North America; Volume: 24; Issue: 4 Linguagem: Inglês

10.1148/24.4.420

1527-1315

Samuel George Schenck, Jacob L. Stein,

Neonatal Respiratory Health Research

PULMONARY cysts of congenital origin are considered a very rare condition. Up to 1925, Koontz (1) was able to collect 108 cases based on autopsy findings, all of which were published in the European literature. His case report, however, was not the first to appear in the American periodicals. In 1913, Pappenheimer (2) described the necropsy of a seven-months premature infant with multiple congenital cystic cavities in the right lung. The child was cyanotic and made some feeble efforts to breathe; he lived for only three hours under artificial respiration. In 1919, Koeckert (3) described an enormous cyst filling the greater part of the chest in a new-born infant who lived for only two hours, with symptoms of cyanosis and marked dyspnea. The microscopic study of the walls of the cyst revealed its bronchial origin. Since 1925, 120 new cases have been collected from the world's literature, 49 of which have been verified by necropsy. This apparent increase of reported cases is due to the fact that clinicians, stimulated by Koontz's paper, are more on the alert to recognize the condition. In addition, roentgenologic technic has been improved considerably, with the result that many new cases have been discovered during life which might otherwise have passed unrecognized. The following interesting case prompted this report. R. S., a male infant, weighed seven pounds four ounces at birth. Labor was normal and the delivery spontaneous. The infant cried lustily at birth. There was no history of illness during the first weeks of life, however, on Aug. 9, 1933, at the age of five weeks, the patient was seen because of insufficient gain in weight, which was then eight pounds four ounces. The child appeared well developed, and on physical examination there was no evidence of any pathology in the chest or elsewhere. The thorax was symmetrical, and both lungfields were apparently negative to percussion and auscultation. However, routine roentgenoscopic examination of the chest revealed a large, circular, dense shadow occupying the middle of the right lung bed. The roentgenograms (Fig. 1), taken on the following day, showed a well circumscribed area of opacity situated in the right pulmonary field and occupying about one-half of the lung space. The pulmonary apex and base were clear, and the left lung bed was normal. No displacement of the heart and mediastinal structures was noted. The lateral view (Fig. 2) showed the ovoid area of opacity to be intrapulmonary, and not part of or connected with the mediastinum or pleural cavity. The roentgen impression was congenital fluid lung cyst, not connected with a bronchus. The infant was again seen on Aug. 19, 1933, at which time his weight was nine pounds eleven ounces, showing a gain of one pound five ounces in 10 days. Since the first visit, he had coughed up brownish fluid, otherwise, the patient had no other symptoms.