대한흉부영상의학회 Weekly Chest Cases

Case No : 844 Date 2013-12-30

Courtesy of Hyun Jung Kim ,Myung Im Ann, Dae Hee Han, Jung Im Jung / Seoul St. Mary hospital
Age/Sex 75 / M
Chief ComplaintRecurrent choking and cough while having meals for 50 years

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Diagnosis With Brief Discussion

Diagnosis: Esophageal Bronchus (Esophageal Lung or Lobe)
Radiologic Findings: Initial chest CT scans revealed focal area of bronchiectasis at the medial basal segment and confluent acinar opacities. Air-containing branching structure was arising suspiciously from the esophagus.
Minimum intensity projection and endoscopy showed the communication of bronchus to the esophagus.
Barium examination (esophagogram) in lateral and anteroposterior views confirmed a communication of the right lower lobe bronchus to the right lateral wall of the esophagus. A few bronchi were ectatic due to recurrent infection.
Brief Review: Esophageal lung or esophageal lobe is one of the entities in the communicating bronchopulmonary foregut malformations (CBPFM). This condition is more common in females, with a ratio 1.5 to 1 as compared to males. The right lung is more commonly involved.
Clinical manifestations are variable, ranging from asymptomatic to life-threatening respiratory failure. The most common presentation is recurrent chest infections with coughing on ingestion of fluids or food. Most of the early presenting patients have poor prognosis.
Confirmation of the diagnosis of esophageal lung is obtained by barium opacification of the esophagus, which shows directly the esophageal bronchus and its first division branches.
Since pulmonary sequestration may be associated with the condition, an angiographic study of the arterial vascularization of the lungs is necessary if conservative surgery has to be performed.
The advanced age of presentation and the absence of symptoms to the bronchial passage of food/fluids emphasize the need to have the possibility of CBPFM in the differential diagosis, even in adults.
References: 1. A. Verma, S. Mohan, M. Kathuria and S.S. Braijal. Esophageal bronchus: case report and review of the literature. Acta radiol 2008; 49: 138
2. D. Lallemand, J.F Quignodon, J.V. Courtel, The anomalous origin of bronchus from the esophagus: report of three cases. Pediatr Radiol 1996; 26:179-182
Keywords: Airway, Congenital,

No. of Applicants : 81

▶ Correct Answer : 13/81, 16.0%

- UWO , Canada S Lee
- Samsung Medical Center , Korea (South) Jihyun LEE
- Goa Medical College , India Paresh Desai
- Kobe City Medical Center General Hospital , Japan Yasuhisa Kurata
- CHU POITIERS , France SZTARK Guillaume
- James Paget Hospital , U.K , United Kingdom nabil mahmood
- Eren T�p Merkezi Istanbul , Turkey Armagan Sarac
- CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
- Niigata University , Japan Atsushi Uehara
- Dong-A University Hospital , Korea (South) Kyun-Jae Lim
- Dong-A University Hospital , Korea (South) Ji-yeon Han
- IRSA La Rochelle , France Denis Chabassiere
- All India Institute of medical sciences , India Justin Moses

▶ Correct Answer as Differential Diagnosis : 5/81, 6.2%

- Niigata City General Hospital , Japan Takao Kiguchi
- Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
- SKG radiology , Australia Yuranga Weerakkody
- C.B.H. Dpt of Imaging-Clinica " MATER DEI" Bari , Italy Carlo Florio
- Medicheck health care , Korea (South) Chae Lim

▶ Semi-Correct Answer : 42/81, 51.9%

- Tokyo Metropolitan Police Hospital , Japan Akifumi Hagiwara
- Kyung Hee University Hospital at Gangdong , Korea (South) Seong Jong Yun
- Avrasya Hospital , Turkey Murat Ulusoy
- radiologist, aditya imaging centre , India vivek patel
- Oita University, Faculty of Medicine , Japan Fumito Okada
- Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- HIA Legouest - METZ , France Alban Gervaise
- district tuberculosis centre,poonamallee , India gayathri ganesh
- University of British Columbia , Canada Amr Ajlan
- Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
- Hopital Bichat , France, Metropolitan Pauline Pradere
- Care Hospital , India prasanna angarakala
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- Seoul university hospital , Korea (South) Youngjin Ryu
- IRSA LA ROCHELLE , France, Metropolitan BIGOT
- HASEK , Turkey bora �zbak�r
- CHu poitiers , France Guillame VESSELLE
- Pneumology GHSR , Reunion fabrice paganin
- McGill University Health Center , Canada Alexandre Semionov
- CAC Rennes , France nicolas gautier
- DTC POONAMALLEE , India Akshay Murali
- Private sector , Greece Vasilios Tzilas
- ICD,MCH CALICUT , India rikhy krishnan
- Saint Malo , France jean-baptiste Noel
- Asan medical center , Korea (South) Sang Young Oh
- Ishikawa Matto Central Hospital , Japan Manabu Akimoto
- the First Affiliated Hospital of NanJing Medical University , China Aiping Chen
- Onomichi municipal hospital , Japan Hirofumi Mifune
- Seoul National University Hospital , Korea (South) Sang Min Lee
- National Hospital Organization Okinawa Hospital , Japan YASUJI OSHIRO
- Dong-A University Hospital , Korea (South) Ki-Nam Lee
- Bach Mai hospital , Viet Nam Hoi Nguyen
- Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
- Columbia Asia , India John Joseph
- Kizawa Memorial Hospital , Japan Yo Kaneko
- Suncheon Plus Medicine and Radiology , Korea (South) Park Sang Hyun
- TCM HOSPITAL OF ZIGONG , China Cao Cunyou
- DELTA CARE HOSPITAL, THANJAVUR, INDIA , India SIVARAJA SUBRAMANIAM
- Teikyo University Mizonokuchi Hospital , Japan Noriko Kobayashi
- Kyungpook National University Hospital , Korea (South) Jaekwang Lim
- kanto Rosai Hp , Japan Takana Yamakawa
- Fukuyama City Hospital , Japan Mayu Uka

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 844 Date 2013-12-30

Discussion

No. of Applicants : 81