대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesArchive of Old Cases

Case No : 1155 Date 2019-12-15

  • Courtesy of So Hyeon Bak, Heon Han / Kangwon National University Hospital
  • Age/Sex 21 / M
  • Chief ComplaintCough, sputum
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Bronchial atresia
Radiologic Findings
Fig 1. Chest radiograph shows a tubular area of increased opacity with decreased vascularity in the right middle lung zone.
Fig 2-5. Axial images of enhanced chest CT show dilated bronchus with air-fluid level in the right upper lobe without communication to central airways and surrounding hyperinflation and hypovascularity of the anterior segment of the right upper lobe.
Brief Review
Bronchial atresia results from local obliteration of a lobar, segmental, or subsegmental bronchus associated with peripheral mucoid impaction and hyperinflation of the obstructed lung segment. The bronchi and alveoli distal to the obliteration develop normally. Bronchial atresia most commonly occurs in the apicoposterior segmental bronchus of the left upper lobe followed by the segmental bronchi of the right upper, middle, and lower lobes. Bronchial atresia is usually asymptomatic and detected incidentally in adults, though some have recurrent pneumonia. Radiologic findings consist of a mucocele with segmental hyperinflation and hypovascularity. Distal hyperinflation is caused by collateral ventilation through intra-alveolar pores of Kohn, bronchoalveolar channels of Lambert, and interbronchiolar channels. CT is the most sensitive imaging modality. Differential diagnoses include allergic bronchopulmonary aspergillosis and any lesion causing bronchial narrowing and thus mucoid impaction.
Please refer to
Case 5, Case 29, Case 327, Case 705, Case 931,
KSTR imaging conference cases 2010 Sprng  Case 12 ,
KSTR imaging conference 2017 Summer  Case 1,
References
1. Gipson MG, Cummings KW. Bronchial atresia. Radiographics. 2009 Sep-Oct;29(5): 1531-5.
Keywords
lung, congenital, bronchial atresia,

No. of Applicants : 55

▶ Correct Answer : 35/55,  63.6%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - McGill , Canada ADRIANA SOFIA MORALES
  • - Ulsan University Hospital , Korea (South) SOYEOUN LIM
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - Chungbuk National University Hospital , Korea (South) YEONGTAE PARK
  • - CH de la Cote Basque , France PAUL ARDILOUZE
  • - Lille , France BENOIST CAPON
  • - NIMS, HYDERABAD , India BHASKAR K
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - , Turkey GOKHAN ARSLAN
  • - Other , Korea (South) SEONGSU KANG
  • - DELTA CARE HOSPITAL, THANJAVUR, INDIA , India SIVARAJA SUBRAMANIAM
  • - , Korea (South) JIN YOUNG LEE
  • - Cabinet Capricorne, clinique sainte-clotilde , Reunion FABIEN HO
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Fujieda Municipal General Hospital , Japan HAYATO NOZAWA
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - , China MEI YUAN
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Samsung Medical Center , Korea (South) KYOWON GU
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Holy Family Hopsital , India RAJESH GOTHI
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - , Japan KAZUMA TERAUCHI
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 6/55,  10.9%
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Myongji Hospital , Korea (South) KI EON KWON
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Kyeongpook National University Hospital , Korea (South) MIRAN KIM
  • - , Korea (South) JANG SEONG WON
  • - Private sector , Greece VASILIOS TZILAS
▶ Semi-Correct Answer : 2/55,  3.6%
  • - Ondokuz Mayis University , Turkey CETIN CELENK
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
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