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Weekly Chest CasesArchive of Old Cases

Case No : 931 Date 2015-08-31

  • Courtesy of Kye Ho Lee, MD / Dankook University Hospital
  • Age/Sex 31 / M
  • Chief ComplaintIncidental abnormality on chest radiograph
  • Figure 1
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Diagnosis With Brief Discussion

Diagnosis
Congenital bronchial atresia
Radiologic Findings
Chest radiograph show hyperlucent left middle lung zone.
Axial and coronal images of non-contrast enhanced chest CT scan show dilated bronchus with air-fluid level in left lower lobe without communication to central airways. Surrounding hypoattenuation and hyperinflation of the affected lung segment indicating air-trapping is noted.
Brief Review
Congenital bronchial atresia is a rare anomaly that results from focal obliteration of a proximal lobar, segmental or subsegmental bronchus that lacks communication with the central airways. The development of distal structures is normal resulting in mucus impaction of the peripheral bronchus. The alveoli supplied by the affected bronchus are ventilated by collateral pathways such as pores of Kohn, channels of Lambert and show regional hyperinflation, parenchymal oligemia around the dilated bronchus. The most involved segment is the apicoposterior segmental bronchus of the left upper lobe, followed by segmental bronchi of the right upper, middle and lower lobes. Bronchial atresia is usually asymptomatic and often diagnosed incidentally in the second and third decades of life. The radiographic finding consists of a bronchocele with or without an air-fluid level and a surrounding hyperlucent lung parenchyma. Differential diagnosis includes allergic bronchopulmonary aspergillosis and any lesion causing bronchial narrowing, mucus impaction. CT is the most sensitive modality, helping exclude the presence of a hilar mass and allow characterization of the lack of communication between the mucocele and the hilum.
References
1. Gipson MG, Cummings KW, Hurth KM, Bronchial atresia. Radiographics 2009; 29:1531-1535.
2. Berrocal T, Madrid C, Novo S, et al. Congenital anomalies of the tracheobronchial tree, lung, and mediastinum: embryology, radiology, and pathology. Radiographics 2004; 24:e17.
Please refer to
Case 29 Case 327 Case 750
Keywords
Airway, Lung, Congenital,

No. of Applicants : 94

▶ Correct Answer : 46/94,  48.9%
  • - Juntendo University Hospital , Japan Akifumi Hagiwara
  • - Tashkent Medical Academy , Uzbekistan Rustam Fayzullaev
  • - Government Medical College, Nagpur, India , India Krishna Prasad Bellam
  • - Kyungpook national university , Korea (South) Chungeun Lim
  • - GHICL , France manuel toledano
  • - University of British Columbia , Canada Amr Ajlan
  • - Asan Medical Center , Korea (South) Jooae Choe
  • - DAYA General Hospital,Thrissur,Kerala , India Raveendran TK
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - Himeji Redcross Hospital , Japan souichirou okamoto
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Wuhan Union Hospital , China Qiguang Cheng
  • - National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
  • - CHRU Lille , France Julien Pagniez
  • - The University of Tokyo Hospital , Japan Takeyuki Watadani
  • - Pusan national university hospital , Korea (South) LEE YOU JIN
  • - Pusan national university hospital , Korea (South) Jin Joo Kim
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia Yuranga Weerakkody
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - University of Tsukuba Hospital , Japan Sodai Hoshiai
  • - �stanbul , Turkey Ayhan Yilmaz
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - Kasturba Medical College , India Chandan Kakkar
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Seoul university hospital , Korea (South) Youngjin Ryu
  • - Asan Medical Center , Korea (South) Hyung Jung Koo
  • - Asan , Korea (South) Sania ALBlushi
  • - Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
  • - Okinawa Kyodo Hospital , Japan Shoko Iraha
  • - IRSA La Rochelle , France Denis Chabassiere
  • - Asan Medical Center , Korea (South) , Korea (South) Han Na Lee
  • - Niigata University , Japan Atsushi Uehara
  • - the first affiliatited hospital of nanjing medical univercity , China Hai Xu
  • - SAKET CITY HOSPITAL , India NIDHI GOYAL
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Scans world , India Philson Mukkada
  • - Gifu Central Hospital , Japan Haruo Watanabe
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
  • - Santosh hospital,Bengaluru , India Pravin Mahadevappa
  • - Kobe City Medical Center General Hospital , Japan Yasuhisa Kurata
  • - Nasaret Hospital , Korea (South) Hee Seok Choi
  • - Medicheck health care , Korea (South) Chae Lim
▶ Correct Answer as Differential Diagnosis : 10/94,  10.6%
  • - Daejin Medical Center Bundang Jesaeng General Hospital , Korea (South) Donghwan Kim
  • - Armed Forces Seoul Hospital , Korea (South) Eui Jin Hwang
  • - Otsu Red Cross Hospital , Japan Hirotsugu Nakai
  • - McGill University Health Center , Canada Alexandre Semionov
  • - National Taiwan University Hospital , Taiwan Li-Ta Keng
  • - Samsung Medical Center , Korea (South) Jeonghyun Lee
  • - Kinki University Faculty of Medicine, , Japan Mitsuru Matsuki
  • - Ajou University hospital , Korea (South) Hun Cho
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
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