Complete resection of an intrapericardial bronchogenic cyst with median sternotomy showing high CA19-9 level fluid sampling by EBUS-TBNA: a case report

An intrapericardial bronchogenic cyst (IBC) is rare and compresses the surrounding organs, causing symptoms. Resection of an IBC leads to an improvement in symptoms. We completely resected an IBC by performing median sternotomy and the symptom improved, and we described the clinical course. A 48-year-old man with palpitation and chest discomfort was referred to our institution. Chest computed tomography (CT) revealed a 42 × 35 × 32-mm cystic mass attached to the right pulmonary artery and right bronchus. Chest CT also revealed that this cystic mass compressed the superior vena cava, right superior pulmonary vein, and left atrium. Endobronchial ultrasonography transbronchial needle aspiration (EBUS-TBNA) revealed a mucinous fluid with high CA19-9 level (> 12,000 U/mL). We performed complete resection of the IBC that firmly adhered to the superior pulmonary vein and left atrium with cardiopulmonary bypass (CPB) using median sternotomy. The postoperative course was uneventful, and the patient was discharged on postoperative day 16 without major complications. The cystic mass was diagnosed as an IBC. He has been well without symptom of chest discomfort and any signs of recurrence for 18 months postoperatively. For complete resection of an IBC, CPB needs to be anticipated for difficulty in predicting firm adhesion to the heart and great vessels. Measuring the CA19-9 level in the sampling fluid with EBUS-TBNA can be useful for the preoperative IBC diagnosis.