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Dr Walles. The patient was a 10-year-old boy weighing 29.1 kg (50th percentile) and was 160.5 cm (50-75th percentile) tall. He was complaining of night sweats, inspiratory pain located under the right costal arches and radiating to the right shoulder, and progressive exhaustion, exertional dyspnea, and weight loss for 1 month. His medical history was unremarkable, and there was no evidence of tuberculosis exposition or tumor disease in his family records. On an outpatient basis, an initial diagnosis of exertional bronchospastic obstruction was made, and he was given bronchodilator inhaled agents without success. Because of this, a plain chest radiograph was made showing a shadow in the right upper thoracic cavity, interpreted initially as pleuritis. To further clarify the diagnosis, a computed tomograph (CT) of the chest was made that showed a tumor mass located in the right hilus, with enlarged lymph nodes in the ipsilateral upper mediastinum. A nuclear magnetic resonance image ruled out additional abdominal masses or lymph nodes. Perhaps at this point we could have the pediatric pneumologist present the findings of the patient at hospital admittance. Dr Freihorst. On admission the patient showed slight congestion of the superficial veins over the chest and abdomen. He was a little tachypneic, with mild intercostal retractions, but had no cyanosis, and breath sounds were vesicular, with minimal wheezing over the right lung. Physical examination was unremarkable otherwise. A sonogram of the neck showed enlarged lymph nodes at the right prescalenic area, and one of them was surgically resected for histologic diagnosis. Serum -human chorionic gonadotropin hormone and -fetoprotein markers and urinary levels of catecholamine were normal. Fiberoptic bronchoscopy showed slight inflammation of the right upper lobe takeoff but no endoluminal tumor or other significant abnormalities, and a bronchoalveolar lavage and a transbronchial biopsy of the enlarged right paratracheal lymph nodes were performed. Dr Kreipe. The pathologic-anatomic examination of the lymph node revealed no evidence of malignancy but showed a nonspecific inflammatory reaction. The same was found in the transbronchial biopsy samples. Dr Freihorst. Transthoracic echocardiography found a distal obstruction of the right pulmonary artery, resulting in a moderate right heart strain. A subsequent right heart catheterization was attempted but was impossible to complete because of the total obstruction of the right pulmonary artery. Dr Galanski. Lung scintigraphy showed normal ventilation patterns but a complete absence of perfusion of the right lung. A second thorax CT confirmed the endoluminal obstruction of the right pulmonary artery (Figure 1) and enlarged lymph nodes and showed normal ventilation patterns. As a new finding, a rich bronchial arterial collateral network provided peripheral lung perfusion (Figure 2). Dr Walles. Thus, we had a 10-year-old boy with a 1-month history of exertional dyspnea and exhaustion due to a total tumoral obstruction of his pulmonary artery From the Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.

Foregut or enterogenous cysts are the result of an abnormal budding or division of the primitive foregut and are usually found in adults. On the basis of histologic features and embryogenesis, they are classified into bronchogenic, esophageal, gastroenteric, and neuroenteric cysts and usually occur in the mediastinum or, less frequently, in the soft tissues of the chest wall. Intrasternal foregut cysts lined by respiratory epithelium have never previously been described in the literature, and we present here the first case.