대한흉부영상의학회 Weekly Chest Cases

Case No : 705 Date 2011-05-02

Courtesy of Eun-Young Kim/Mi-Young Kim / University of Ulsan, College of Medicine, Asan Medical Center.
Age/Sex 42 / F
Chief ComplaintIncidental abnormality on chest radiograph.

Figure 1
Figure 2
Figure 3

Figure 1

Diagnosis With Brief Discussion

Diagnosis: Bronchial Atresia
Radiologic Findings: Chest radiograph (Figure 1) shows hyperlucent right lower lobe with irregular calcified density. Transverse image of chest CT (Figuew 2) shows absence of the anterior and medial basal segmental bronchi of the right lower lobe. Proximal bronchi are dilated and filled with mucoid plug.Note hyperinflation and hyperlucency of the affected segments. Coronal image of non contrast enhanced chest CT (Figure 3)shows mucoid plug with calcium deposition in dilated bronchus of the right lower lobe.
Brief Review: Bronchial atresia is characterized by focal interruption of lobar, segmental, or subsegmental bronchus associated peripheral mucus impaction and hyperinflation of the obstructed lung segment. The common sites of involvement in bronchial atresia are the apicoposterior segmental bronchus of the left upper lobe and segmental bronchi of the right upper lobe, middle lobe, and occasionally the lower lobe. Pathogenesis may relate to intrauterine interruption of bronchial arterial blood supply, resulting in ischemia and scarring or discontinuity between the cells at the tip of a bronchial bud with the bud itself. The distal branches can develop normally in the absence of a connection between the distal and central airways. The radiographic features include a hilar mass and hyperinflation of the peripheral lung secondary to entrapment of air admitted via collateral air drift. The dilated bronchi contain retained secretions and can have a varied appearance. The characteristic CT features are as follows: The supplying bronchus is atretic, and there is a hilar mass. The dilated bronchi beyond the atresia are completely opaque or demonstrate air-fluid levels or occasionally may be purely air filled. These patients are usually asymptomatic and do not require surgery. The major indication for surgery is repeated infections.
References: 1. Matthew G, Kristopher W, Kyle M, et al. Best case from AFIP: Bronchial atresia. Radiographics 2009;29:1531-1535.
2. Carl F, Wiliam R, David L, Chad H, et al. Developmental lung anomalies in the adult: Radiologic-pathologic correlation. Radiographics 2002;22:525-543.
Keywords: airway, congenital,

No. of Applicants : 90

▶ Correct Answer : 40/90, 44.4%

- Assam Medical college , India samudra borah
- University of British Columbia , Canada Amr Ajlan
- Oita University, Faculty of Medicine , Japan Fumito Okada
- KMC,Manipal , India satish maddukuri
- Hangang sacred heart hospital , Korea (South) You Mie Han
- Doctors Hospital , Bahamas muneesh sharma
- Okayama University , Japan Akihiro Tada
- Montreal , Canada D J
- NEPEAN HOSPITAL , Australia YOGESH THAKKAR
- , Korea (South) Pyeong Guk Kang
- Chung-Nam National University Hospital , Korea (South) KI-TAE HAN
- Calcutta Heart Research Centre, Kolkata , India Pankaj Nagori
- PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
- CHU NANCY , France, Metropolitan GREGORY LESANNE
- jaslok hospital & research centre mumbai , India JAINENDRA JAIN
- Louisiana State University - Shreveport , United States Carlos Previgliano
- Teleradiology , India Savith Kumar
- Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
- Government Medical college, Kozhikkode , India jineesh thottath
- Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
- Yonsei University College of Medicine, Shinchon Severance hospital , Korea (South) Young Joo Suh
- All India Institute of Medical Sciences , India Ashish Gupta
- Seoul St Mary Hospital , Korea (South) Chaehun Lim
- McGill University Health Center , Canada Alexandre Semionov
- Armed Forces Yangju Hospital , Korea (South) Ho-Joon Lee
- HSC , Brazil Diogo Pinheiro
- Severance hospital , Korea (South) Saerom Hong
- NTUH , Taiwan Kuei-pin Chung
- Department of Diagnostic Radiology, Chonbuk National University Hospital , Korea (South) Eun Jung Choi
- Osaka University , Japan Hiromitsu Sumikawa
- Onomichi municipal hospital , Japan Ryotaro Kishi
- Youngdong Hospital , Korea (South) Sang Min Lee
- kobe city general hospital , Japan rintaro hashimoto
- Mallinckrodt Institute of Radiology , United States Travis Henry
- Beaulieu clinic Geneva , Switzerland gilles GENIN
- Mallinckrodt Institute of Radiology , United States Naganathan Mani
- Chonnam National University Hospital , Korea (South) Jung hyun Kim
- Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
- Saga University , Japan Ryoko Egashira
- Hanyang university medical center , Korea (South) YOONAH SONG

▶ Correct Answer as Differential Diagnosis : 15/90, 16.7%

- Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- Auckland hospital , New Zealand (Aotearoa) Yuranga Weerakkody
- clinique de SAVOIE , France, Metropolitan gay-depassier philippe
- NDMVP Nashik , India Imran Jindani
- Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
- Onomichi municipal hospital , Japan Hirofumi Mifune
- SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
- Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
- Himchan Hospital , Korea (South) Kwon Hyoung Kim
- IRSA , France jean-luc BIGOT
- IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
- Hotel-Dieu Montreal , Canada nicolas gautier
- IRSA La Rochelle France , France Denis Chabassiere
- Fukuyama daiichi Hospital , Japan Mototsugu Saeki

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 705 Date 2011-05-02

Discussion

No. of Applicants : 90