Acquired pulmonary stenosis due to compression by a bronchiogenic cyst.

A case of pulmonary stenosis due to extrinsic compression of the pulmonary artery and right ventricular infundibulum is reported. It is believed that this is the first such case recorded in the English literature where the cause of the compression was a bronchiogenic cyst. Pulmonary stenosis due to compression of the right ventricular outflow tract by an extrinsic mass is an uncommon but well-documented event. The recorded causes include lymphoma, teratoma, thymoma, bronchial carcinoma, pericardial sar-coma, and aneurysm of the ascending aorta The case reported here appears to be the first in the English literature in which the cause of the compression was a bronchiogenic cyst. CASE REPORT The patient was a 3-year-old girl who was referred from Barbados to the University Hospital of the West Indies, Jamaica on 29 October 1970 for investigation of suspected pulmonary valve stenosis. She was free of symptoms but a chest radiograph taken at the time of a respiratory tract infection had revealed a large intrathoracic opacity. The antenatal and obstetric history was normal. Physical examination showed that she was small for her age but alert and lively. A left-sided prae-cordial bulge was present and the apex beat was in the left fifth intercostal space on the nipple line. A systolic thrill was palpable along the left sternal border and there was an ejection systolic murmur which was loudest in the third and fourth intercostal spaces just to the left of the sternum. Signs of cardiac failure were absent. There was a dull percussion note and absence of breath sounds over the upper half of the left side of the chest anteriorly. No other abnormal physical signs were found. INVESTIGATIONS Chest radiographs (Fig. 1) showed a large mass in the position of the left upper lobe. dominance with a mean QRS axis of +240'. Cardiac catheterization was performed and a pressure gradient of 45 mmHg across the pulmonary valve was demonstrated (Fig. 2). Angiocardiograms showed that the infundibulum, the main pulmonary artery, and left pulmonary artery were all pushed inferiorly and to the left by a large, avascular mass in the position of the left upper lobe (Fig. 3). OPERATION A large cystic mass was removed by median sternotomy on 9 November 1970. The mass was situated in the superior anterior mediastinum, extending inferiorly in front of the right ventricle and laterally to fill the upper third of the left hemi-thorax. It occupied the …