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Weekly Chest CasesArchive of Old Cases

Case No : 327 Date 2004-01-31

  • Courtesy of Yo Won Choi, M.D. / Hanyang University Hospital, Seoul, Korea
  • Age/Sex 52 / F
  • Chief ComplaintIncidental abnormality on a chest radiograph
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Congenital bronchial atresia
Radiologic Findings
A chest radiograph shows a nodule in the right upper lung zone. No other abnormality is evident. CT scans show branching soft-tissue opacity and surrounding hyperlucency in the apical segment of the right upper lobe. The lesions show neither calcification or enhancement. The other areas appear normal.
Fiberoptic bronchoscopy did not find any opening to the apical segment of the right upper lobe, and the expected bronchial opening site appeared smooth and was covered with the normal mucosa.
Brief Review
Congenital bronchial atresia is an anomaly characterized by obliteration of the proximal lumen of a segmental bronchus, with preservation of the distal structures. The areas most frequently involved are the apical and posterior segments of the left upper lobe, followed by the segmental bronchi of the right upper lobe, middle lobe, and rarely a lower lobe. The bronchial tree proximal to the atresia is patent. The mucous secretions generated in the bronchi accumulate at the point of obstruction. Air enters the affected segment via collateral channels, producing overinflation.

The radiographic findings mirror the pathologic changes: the affected area is darker than the surrounding lung, and, on radiographs obtained at expiration, obstructive emphysema is obvious. The accumulated secretions appear as areas of mucous impaction, which may have the typical branching pattern. The findings on CT scans are the same as those observed on chest radiographs, namely, segmental overinflation and mucous impaction, which are the hallmark of this condition.
References
1. Fraser RG, Pare JAP, Fraser RS, Genereux GP, eds. Congenital bronchial atresia. In: diagnosis of diseases of the chest. 3rd ed. Philadelphia: Saunders, 1989; 721-722.

2. Mata JM, Caceres J, Lucaya J, Garcia-Conesa JA. CT of congenital malformations of the lung. RadioGraphics 1990;10:651-674.

3. Remy-Jardin M, Remy J, Ribert M, Gosselin B. Bronchial atresia: diagnostic criteria and embryologic considerations. Diagn Intervent Radiol 1989;1:45-51.
Keywords
Airway, Congenital,

No. of Applicants : 28

▶ Correct Answer : 12/28,  42.9%
  • - Annecy Hospital, France Gilles Genin
  • - CH Lyon sud, France Xavier Riviere
  • - Dong-A University Hospital, Korea Ki-Nam Lee
  • - Ewha Woman's University Hospital, Korea Sung Shine Shim
  • - Ewha Woman's University Hospital, Korea Yoo Kyoung Kim
  • - Incheon Sarang Hospital, Korea Jung Hee Kim
  • - Gwangmyoung Sung-Ae Hospital, Korea Jiyong Rhee
  • - Kyung Hee university medical center, Korea Sang-Won Kim
  • - Mallinckrodt Institute of Radiology, USA Jin Mo Goo
  • - Nowon Eulji hospital, Korea Jeong Joo Woo
  • - Social Security Hospital, Ankara, Turkey Meric Tuzun
  • - Upasana Hospital, Kollam, India Joy A Thomas
▶ Semi-Correct Answer : 4/28,  14.3%
  • - CIM Saint Dizier, France JC Leclerc
  • - Hangang SacredHeart Hospital, Korea Eil Seong Lee
  • - Korea University Guro Hospital, Korea Hwan Suk Yong
  • - Tokyo Koseinenkin Hospital, Japan Noriatsu Ichiba
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