What are cysts?
Congenital cysts are formed in utero when the branching of the bronchi is disrupted; they can be single or multiple and sometimes appear already in childhood. Acquired ones appear at the site of previous inflammation: after an abscess, destructive pneumonia, tuberculosis cavity or injury. A separate group includes emphysema bullae - thin-walled air cavities that are prone to rupture. It is also important to remember about parasitic cysts caused by Echinococcus, which are common in livestock-raising regions and require a different approach.
- Congenital single and multiple cysts
- Acquired after abscess and pneumonia
- Post-tuberculosis cavities
- Bullae with emphysema
- Parasitic cysts in echinococcosis
- Air and liquid filled
Causes and risk factors
Congenital forms are associated with impaired development of the respiratory tract in the fetus, and it is impossible to influence this. Acquired cysts most often result from severe lung infections, so timely treatment of pneumonia and abscess reduces the risk. Bullae form in smokers with emphysema, as well as in tall, thin young men in whom spontaneous pneumothorax is possible. Echinococcal cysts occur when infected from dogs and contaminated foods, especially in rural areas.
- Disorders of bronchial development in the fetus
- Previous abscess or destructive pneumonia
- History of tuberculosis
- Smoking and emphysema
- Chest injuries
- Contact with dogs and infection with echinococcus
- Tall growth and asthenic physique for bulls
Symptoms
An uncomplicated cyst usually does not manifest itself in any way. Large cavities can compress the surrounding tissue and cause shortness of breath on exertion, a feeling of heaviness in the chest, and a dry cough. When suppuration occurs, the picture changes dramatically: the temperature rises, chills, weakness, and a cough with copious purulent sputum, sometimes with a smell, appear. A ruptured cyst is accompanied by sudden chest pain and increasing shortness of breath - this is a pneumothorax that requires immediate help. Hemoptysis is less common.
- Most often there are no complaints
- Shortness of breath with large cysts
- Dry cough and chest heaviness
- Temperature and purulent sputum during suppuration
- Sudden chest pain when ruptured
- Hemoptysis
- Repeated pneumonia in the same area
Diagnostics
X-ray reveals a rounded clearing or cavity with a fluid level, but computed tomography is needed to assess the wall, contents and connection with the bronchus. It also helps to distinguish a simple cyst from an abscess, tuberculous cavity and disintegrating tumor, which is fundamentally important for tactics. If a parasitic origin is suspected, serological tests and ultrasound of the liver are performed, since echinococcus often affects it too. Spirometry evaluates the effect on breathing, and if the picture is unclear, bronchoscopy or biopsy is discussed.
- Chest X-ray
- CT scan of the chest is the main method
- Comparison with previous images
- Tests for echinococcosis if suspected
- Sputum examination for tuberculosis
- Spirometry
- Bronchoscopy or biopsy if in doubt
Treatment and observation
A small, asymptomatic cyst is usually observed with repeat CT scans at intervals determined by the physician. In case of suppuration, antibacterial therapy is prescribed, and if necessary, the cavity is drained. Surgical removal is discussed for large cysts compressing the lung, repeated suppuration, hemoptysis, recurrent pneumothorax, and if it is impossible to exclude a tumor. Parasitic cysts are removed surgically with mandatory accompanying antiparasitic treatment. Smokers are strongly advised to quit tobacco.
- Observation with control CT scan in the absence of complaints
- Antibacterial therapy for suppuration
- Drainage of the cavity according to indications
- Surgical removal of a cyst or part of the lung
- Treatment of hydatid cysts with antiparasitic drugs
- Quitting smoking
- Avoiding pressure drops with large bullae
