Imaging Sciences Interesting Cases
Case 332
Veniamin Barshay, MD
Clinical Presentation: Patient is a 44-year-old male presenting with dyspnea and abnormal breath sounds.
Imaging Findings: Radiograph demonstrates branching opacity in the right lower lobe and hyperlucency of the adjacent lung. The CT scan shows branching tubular opacity in the right lower lobe with air trapping.
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Figure 1. |
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| Figure 2. |
| Figures 1-2: Arrows point at the atretic bronchus with mucus impaction. Arrowhead indicates air trapping. |
Diagnosis: Bronchial atresia
Discussion: Bronchial atresia is a pulmonary anomaly in which a segmental bronchus does not communicate with the central airway. The etiology is uncertain. Theories include the in utero vascular insult (15-16 week of gestation) vs. separation of pulmonary bud (5-6 week of gestation). The latter theory would explain occasional coexisting pulmonary sequestration and bronchogenic cysts. The bronchi distal to the stenosis become filled with mucus. The alveoli are ventilated by collateral pathways and show air trapping resulting in hyperinflation of the affected segments.
Patients are usually asymptomatic and the diagnosis is incidental. Symptomatic patients present with recurrent pulmonary infection. The treatment is usually conservative. Complex cases with recurrent infections may require surgical resection.
References:
- Berrocal T, Madrid C, Novo S, Gutiérrez J, Arjonilla A, Gómez-León N. Congenital anomalies of the tracheobronchial tree, lung, and mediastinum: embryology, radiology, and pathology. Radiographics. 2004 Jan-Feb;24(1):e17. PMID: 14610245 [PubMed]