Discussion
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,