INFECTED SIMULTANEOUS MEDIASTINAL BRONCHOGENIC CYST AND ESOPHAGEAL DUPLICATION CYST MASQUERADING AS A LUNG ABSCESS

TOPIC: Genetic and Developmental Disorders TYPE: Fellow Case Reports INTRODUCTION: Bronchogenic esophageal duplication cysts are rare but significant developmental anomalies. We present a case with both types of cyst in single mass mimicking lung abscess protracted treatment course. CASE PRESENTATION: A healthy 26-year-old female was admitted onset left sided pleuritic chest pain fever over 24 hours. Her exam remarkable for tachycardia; she had elevated markers infection. Computed tomography (CT) revealed well-demarcated cystic the hemithorax an air-fluid level. She no prior imaging denied aspiration events or substance use. thought to have intraparenchymal abscess, underwent CT guided drainage frank purulent material. Because suspected location drain placed. Fluid cultures cytology were negative her sputum grew mucoid pseudomonas aeruginosa, which atypical pathogen this patient. treated four weeks intravenous cefepime, two levofloxacin metronidazole, serial imaging. Pleuritic persisted despite regression lesion 10-month period (Figures 1-3); after resection through video-assisted thoracic surgical approach. Intraoperatively, large densely adherent inflammatory connected esophagus without intraluminal connection. Thick fluid from sent culture cytology, again negative. Pathology consistent (EC) (Figure 4B) additional noncommunicating bronchogenic (BC) 4A). At 6months follow-up visit, doing well free symptoms. DISCUSSION: To our knowledge is first report de-novo infected dual BC/EC adult. Our highlights need consideration congenital while working up abscesses. The diagnosis may be difficult resection, as characteristic findings missing half cases. 1There likely role diagnostic therapeutic purposes, however efficacy safety data limited.2 optimal timing also not clear, especially asymptomatic cysts. There minimal evidence support universal though symptomatic will continue intervention. 2,3 CONCLUSIONS: Infected can challenge. Atypical presentations, lack improvement appropriate therapy, important clues diagnosis. REFERENCE #1: St-Georges R, Deslauriers J, Duranceau A, Vaillancourt Deschamps C, Beauchamp G, Pagé Brisson J. Clinical spectrum mediastinum Ann Thorac Surg 1991; 52:6–13. #2: Kirmani B, Sogliani F. Should adults conservatively surgery? Interact Cardiovasc Surg. 2010 Nov; 11(5): 649-59. #3: Fievet L, Gossot D, de Lesquen H, Calabre Merrot T, Thomas P, Becmeur F, Grigoroiu M. Resection versus patients: outcome analysis, Annals Thoracic Surgery (2020) DISCLOSURES: disclosure on file Gary Hochhheiser; No relevant relationships by Obieze Nwanna Nzewunwa, source=Web Response Edmund Sears, Hilamber Subba,