Bronchial atresia

Case contributed by Jan Frank Gerstenmaier

Presentation

Gradual worsening dyspnea over several years. There was no clear history of childhood infection.

Patient Data

Age: 35 years
Gender: Female

Chest radiograph

x-ray

The heart size and contour are normal.  There is hyperlucency of the left upper and mid zone without hyperexpansion or volume loss. Central branching opacity. No pneumothorax. No consolidation or pleural effusion. The right lung appears normal.

CT

ct

There is a focal area of hypoattenuation involving much of the left upper lobe.  There is reduced vascularity within this hyperlucent segment.  Centrally, there is a bronchocele. No evidence of over expansion of the lobe. A posterior mediastinal mass is incidentally seen, slightly above fluid density and most likely representing a bronchopulmonary foregut duplication cyst.

Qantitative V/Q scan

Nuclear medicine
Quantitative analysis demonstrates photopenia within the superolateral aspect of the left upper lobe on the perfusion study with less pronounced defect on ventilation.

Post-operative chest radiograph

x-ray

Surgical clips projected over the left upper zone and left sided volume loss in keeping with left upper lobectomy.

Case Discussion

Segmental hyperlucency secondary to gas trapping with a central bronchocele are the typical findings of bronchial atresia. 

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