Bronchial atresia

Bronchial atresia is a developmental anomaly characterised by focal obliteration of the proximal segment of a bronchus associated with hyperinflation of the distal lung. 

On imaging, it commonly presents as a proximal focal tubular shaped opacity radiating from the hilum associated with a distal area of hyperlucent lung parenchyma. 

Bronchial atresia is usually asymptomatic and may be found incidentally. If symptomatic, it may cause shortness of breath, cough or rarely infection. 

The exact cause of bronchial atresia is not well known. Focal bronchial interruption appears to occur before birth. As the bronchial pattern is entirely normal distal to the site of stenosis, it has been suggested that atresia is probably secondary to a traumatic event during fetal life rather than a result of abnormal growth and development 5.

The bronchi distal to the atresia become filled with mucus and may form a mucocoele/bronchocoele. The lung distal to the atretic bronchus develops normally but is overinflated due to collateral air drift with air trapping.

Location

It is typically at the segmental or subsegmental level. It can involve any lobe but most commonly occurs at the apico-posterior segment of the left upper lobe, 2 followed by right upper lobe.

Plain radiograph

It usually presents as a proximal focal ovoid or tubular shaped opacity (finger-in-glove) radiating from the hilum associated with a distal area of hyperlucent lung. 

CT
  • atretic bronchial stump(s) often become(s) mucus plugged and can give a finger-in-glove appearance
  • distal lung parenchyma supplied by the atretic segment can be hyperlucent due to oligemia and air trapping with air entering through pores of Kohn

HRCT features are usually typical but segmental resection may be done in some cases to rule out a rare possibility of underlying small malignancy as the cause of obstruction 3

Complications

Although it is usually an incidental finding, it may be associated with recurrent infections in 20% of patients.

It is thought to have been first described in 1953 by Ramsay et al. in a series of patients with cystic lung disease 5.

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Article Information

rID: 1020
Systems: Chest, Paediatrics
Section: Gamuts
Tag: cases
Synonyms or Alternate Spellings:
  • Congenital bronchial atresia
  • Bronchial atresia (BA)
  • Bronchial atresias

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    Case 1: with distal air trapping
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    Bronchial atresia
    Case 2: left sided
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