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What Is Your Diagnosis?

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Figure 1Right lateral (A), left lateral (B), and dorsoventral radiographic (C) views of the thorax of a 7-day-old Red Angus bull calf
with a 3-day history of dyspnea.

History
A 7-day-old Red Angus bull calf with a history of respiratory distress of 3 days duration was evaluated. This calf had been
unthrifty since birth. At the onset of respiratory distress, the owner administered ceftiofur crystalline-free acida (6.6 mg/kg [3
mg/lb], SC, once), with no obvious improvement. On physical examination, the calf was dull but alert and responsive. The calf
was tachypneic (100 breaths/min [reference range, 30 to 60 breaths/min]) and cyanotic. Mild dehydration and scleral injection
were present. On auscultation of the thorax, lung sounds were increased on the left side and markedly decreased to absent on
the right. At this time, supplemental oxygen was provided, with a subsequent mild reduction in respiratory rate. A CBC revealed
a stress leukogram (18,614 neutrophils/L [reference range, 600 to 4,000 neutrophils/L], 1,589 lymphocytes/L [reference
range, 2,500 to 7,500 lymphocytes/L], and 2,497 monocytes/L [reference range, 0 to 200 monocytes/L]) and a mildly high
Hct (47%; reference range, 25% to 45%). Serum biochemical analysis results were largely unremarkable, with the exception of
a moderately low total protein concentration (5 g/dL; reference range, 7 to 8.9 g/dL) and a mildly low globulin concentration
(2.2 g/dL; reference range, 2.5 to 4.4 g/dL). Three-view thoracic radiography was performed (Figure 1).
Determine whether additional imaging studies are required, or make your diagnosis from Figure 1then turn
the page
This report was submitted by Elizabeth C. Hiebert, DVM; Kathy A. Clarke, DVM, PhD; Sherrill A. Fleming, DVM; and Michael W. Thomas,
DVM, MS; from the Departments of Clinical Sciences (Hiebert, Thomas) and Pathology and Population Medicine (Clarke, Fleming), College
of Veterinary Medicine, Mississippi State University, Mississippi State, MS 39762. Dr. Hieberts present address is Central Texas Veterinary
Specialty Hospital, 4434 Frontier Trail, Austin, TX 78745. Dr. Hiebert was a third-year veterinary student at Mississippi State University at the
time this calf was evaluated.
No third-party funding or support was received in connection with this case or the writing or publication of the manuscript.
The authors declare that there were no conflicts of interest.
Address correspondence to Dr. Hiebert (ehiebert2014@gmail.com).
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Radiographic Findings and Interpretation

A large, rounded, sharply delineated, thin-walled
intrapulmonary structure occupies the right middle and
caudal lung lobes and extends across the midline into
the left caudomedial aspect of the thorax (Figure 2). The
structure is made up of mixed fluid and gas opacities
but is largely radiolucent in the right middle aspect
of the thorax. The mediastinum and cardiac silhouette are deviated cranially and to the left. A mixed
alveolar to interstitial pattern is present in the left
cranial and caudal lung fields, suggesting nonobstructive compressive atelectasis. The thorax appears
overdistended with elevation of the ribs and caudal
displacement of the diaphragm. Differential diagnoses include congenital lobar emphysema, pulmonary
and bronchogenic cysts, pulmonary blebs, and emphysematous bullae.
Treatment and Outcome
Left-sided thoracocentesis yielded 20 mL of serous
modified transudate. Euthanasia was elected, and the
calf was submitted for necropsy. Gross examination revealed marked inflation of the right caudal lung lobe
into a large (32 X 23 X 15-cm) gas-filled balloon-like
1008

Vet Med Today: What Is Your Diagnosis?

Figure 2Same radiographic images as in Figure 1. Multiple rounded, multilobulated, mixed fluid and gas opacity intrapulmonary structures are seen overlying the cardiac silhouette and spread throughout the middle and caudal lung fields on the right and left lateral
views (short and long arrows). Overdistension of the thorax with
elevation of the ribs and caudal displacement of the diaphragm are
also seen on the left lateral and dorsoventral views (bracket). On
the dorsoventral view, a large, round, radiolucent intrapulmonary
structure surrounded by multiple small, thin-walled, multilobulated
structures is clearly seen in the right middle and caudal lung fields
extending across midline into the left caudomedial aspect of the thorax (straight arrows). The cardiac silhouette and mediastinum are deviated cranially and to the left (curved arrow), and the mixed alveolar
to interstitial pattern within the left cranial and caudal lung fields is
highly suggestive of nonobstructive compressive atelectasis.

structure that occupied > 75% of the thoracic cavity

and displaced the diaphragm caudally. All other lung
lobes were severely atelectatic. Histologic examination
of the right caudal lung lobe showed that distended sections of the lung lobe were lined by pseudostratified
columnar to cuboidal epithelium that resembled bronchiolar epithelium. The epithelial cells were supported
by thick fibrous connective tissue, and the structure
was separated from adjacent pulmonary lobules by emphysematous interlobular septa. These findings were
consistent with a diagnosis of a congenital intrapulmonary bronchogenic cyst.
Comments
Bronchogenic cysts are congenital cystic lesions resulting from the abnormal development of the tracheobronchial tree during the embryonic period.1 Bronchogenic cysts have extremely dilated bronchi or bronchioles
that are often distinctly demarcated, with bronchial epithelium within the cyst wall.2 In humans, multiple forms
have been described, including both intrathoracic (mediastinum and lung parenchyma) and extrathoracic (neck,
JAVMA, Vol 247, No. 9, November 1, 2015

retroperitoneal, or subcutaneous) forms.1 Few reports24

of bronchogenic cysts are available in the veterinary literature; however, intrathoracic forms can be associated with
dyspnea and decreased respiratory sounds within the affected lung fields.
Diagnostic imaging is an invaluable aid to diagnosing bronchogenic cysts. Radiologically, bronchogenic
cysts present as sharply defined, solitary, round to ovoid
structures with air, water, or mixed opacities.5 Computed tomography complements radiographic findings;
communication with a bronchus in combination with
no contrast uptake is characteristic of these congenital
anomalies.35
Complete surgical excision is the preferred treatment for bronchogenic cysts in human patients and is associated with an excellent prognosis.5 The few reports14

that exist in veterinary medicine suggest that this may be

the ideal treatment for animal patients as well.
a.

Excede, Zoetis, Florham Park, NJ.

1.

Lee JY, Yoon IH, Cho SW, et al. Congenital cervical bronchogenic cyst in a calf. J Vet Diagn Invest 2010;22:479481.
Dahl K, Rrvik AM, Lanageland M. Bronchogenic cyst in a German Shepherd Dog. J Small Anim Pract 2002;43:456458.
Berchtold B, Meylan M, Gendron K, et al. Successful treatment
of an intrathoracic bronchogenic cyst in a Holstein-Friesian
calf. Acta Vet Scand 2013;55:14.
Gadbois J, Blond L, Lapointe C, et al. Computed tomographic
evaluation of a bronchogenic cyst in a German Shepherd Dog.
Can Vet J 2012;53:8688.
Limaem F, Ayadi-Kaddour A, Djilani H, et al. Pulmonary and
mediastinal bronchogenic cysts: a clinicopathologic study of 33
cases. Lung 2008;186:5561.

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3.
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