bronchial atresia

School ager
with cough and fever. Inspiratory CXR AP (upper left) shows increased lucency in the left upper lobe when compared to the right upper lobe while expiratory CXR AP (upper right) shows air trapping in the left upper lobe. Magnified view of the upper lobes (below) better shows a round lesion in the lower portion of the left upper lobe which represents mucous trapped distally to an area of atresia in a bronchus.The diagnosis was bronchial atresia.
pediatricimaging.org • CC-by-nc-sa 4.0
Newborn with
respiratory distress. CXR AP (above) shows subtle increased lucency of the right middle lobe. AP and oblique images from a vintage bronchogram 3 years later performed by injecting contrast in the right mainstem bronchus (below) shows a hyperlucent and hyperexpanded right middle lobe and contrast filling the airways of the collapsed right upper lobe and the right lower lobe but no contrast filling the airways of the hyperexpanded right middle lobe.The diagnosis was bronchial atresia of the right middle lobe.
pediatricimaging.org • CC-by-nc-sa 4.0
Bronchocele
caused by congenital bronchial atresia. Axial (a and b), coronal (c), sagittal (d) mediastinal window sections and sagittal parenchymal (e) window section show branching lobulated mass with a homogeneously low density in the apicoposterior segment of the left upper lobe.
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Bronchocele
caused by congenital bronchial atresia. Axial (a and b), coronal (c), sagittal (d) mediastinal window sections and sagittal parenchymal (e) window section show branching lobulated mass with a homogeneously low density in the apicoposterior segment of the left upper lobe.
www.eurorad.org • CC by-nc-sa-4.0
Bronchocele
caused by congenital bronchial atresia. Chest X-ray showing a branching nodular opacity with well-defined borders in the apicoposterior segment of the left upper lobe. There is no pleural effusion.
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The postnatal
differential diagnosis of four patients with antenatal diagnosis of congenital pulmonary airways malformation (CPAM). Left hilar mass lesion
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Imaging of
congenital lung diseases presenting in the adulthood: a pictorial review. Mixed lesions-pulmonary sequestration and bronchial atresia in a 45-year-old asymptomatic female. Coronal CT image shows bronchial atresia with the finger-in-glove appearance (a, arrow). Hyperinflation of the obstructed lung area is observed on both coronal (a) and quantitative 3D reconstruction CT images (blue area) (b). Axial (c) and coronal (d) maximum intensity projection (MIP) images demonstrate pulmonary sequestration supplied from an aberrant artery arising from the right inferior phrenic artery (arrows). Bronchial atresia is also seen on the coronal MIP image (red arrow)
insightsimaging.springeropen.com • CC-by-4.0
Imaging of
congenital lung diseases presenting in the adulthood: a pictorial review. Imaging features of bronchial atresia in two asymptomatic patients. Central mass-like opacity because of the mucus-filled bronchus is seen on coronal (a, c) and sagittal (b) CT images. Coronal (a) and sagittal (b) CT images in the expiratory phase and quantitative 3D reconstruction (d) image clearly show hyperinflation (d, blue area) due to air trapping
insightsimaging.springeropen.com • CC-by-4.0
The postnatal
differential diagnosis of four patients with antenatal diagnosis of congenital pulmonary airways malformation (CPAM). There is hypo-attenuation of the left upper lobe apical-posterior segments on inspiration and expiration in keeping with hyper-expansion and air trapping.
www.eurorad.org • CC by-nc-sa-4.0
The postnatal
differential diagnosis of four patients with antenatal diagnosis of congenital pulmonary airways malformation (CPAM). There is a left hilar mass lesion measuring 2.8 x 1.6 x 1.9 cm with a 1cm cystic component that represents a short segment of dilated bronchus.
www.eurorad.org • CC by-nc-sa-4.0
Congenital
bronchial atresia presenting as a cavitary lesion on chest radiography: a case report. A CT scan of the chest reveals the cavitary lesion with the air-fluid level in it and the distal oligemia and hyperlucency of the lung.
casesjournal.biomedcentral.com • CC-by-2.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Bronchial atresia is a developmental anomaly characterized 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.

Clinical presentation

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

Pathology

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 .

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 apicoposterior segment of the left upper lobe,followed by the right upper lobe .

Radiographic features

Plain radiograph

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

CT
  • atretic bronchial stump(s) often become(s) plugged with mucus 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

Treatment and prognosis

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

Complications

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

History and etymology

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

Differential diagnosis

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Bronchialatresie:
Allergische
bronchopulmonale Aspergillose
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kongenitales
lobäres Emphysem
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kongenitale
Anomalien des Tracheobronchialsystems
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Trachealatresie
 
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