Bronchial atresia
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American Roentgen Ray Society Images of Bronchial atresia |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Bronchial atresia is a disorder in which a segmental bronchus fails to connect with or communicate with the more central airways. [1] [2] [3] [4] [5]
Pathophysiology and Etiology
The underlying basis of the disorder is not clear. It has been hypothesized to be the result of a vascular injury to the lung at approximately 15 to 16 weeks gestation. An alternate hypothesis is that the disorder occurs secondary to separation of the bronchial bud during the 5th to 6th week of gestation. Pulmonary sequestration and bronchogenic cysts also form during this early period of fetal development and may share an underlying pahtophysiology.
The most common anatomic locations include the following:
- The apical posterior segment of the left upper lobe
- The left lower lobe
- The right middle lobe
Epidemiology and Demographcis
Females outnumber males 2:1.
Diagnosis
Symptoms and History
The majority of patients are asymptomatic and the mass is discovered as an incidental finding on a routine chest X ray.
If a patient is symptomatic, they complain of dyspnea, cough and wheezing.
By history the patient may have recurrent pulmonary infections.
Physical Examination
Lungs
Decreased breath sounds may be present in the affected lung fields.
Chest X Ray
The chest x ray findings are mucoid impaction of a bronchus yielding a branching tubular mass which is surrounded by hyperinflated lung and decreased vascular markings. The differential diagnosis of these radiographic findings include the following:
Computed Tomography
This is the imaging modality of choice for diagnosing bronchial atresia and demonstrates segmental emphysematous changes beyond the mucous impaction in the bronchus.
Treatment
Conservative management is the usual course of treatment. However, if the patient is symptomatic with respiratory compromise or if their course is complicated by recurrent infection, then surgical resection may be helpful.
References
- ↑ Cohen AM, Solomon EH, Alfidi RJ. Computed tomography in bronchial atresia. American Journal of Roentgenology, 1980;135:1097-99.
- ↑ Rappaport DC, Herman SJ, Weisbrod GL. Congenital bronchopulmonary diseases in adults: CT findings. American Journal of Roetgenology, 1994;162: 1295-99.
- ↑ Kinsella D, Sissons G, Williams MP. The radiological imaging of bronchial atresia.British Journal of Radiology 1992;65:681-85.
- ↑ Shady K, Siegel MJ, Glazer HS. CT of focal pulmonary masses in childhood. Radiographics, 1992;12:505-514.
- ↑ Kuhn C, Kuhn JP. Coexistence of bronchial atresia and bronchogenic cyst: Diagnostic criteria and embryologic considerations. Pediatric Radiology 1992;22:568-70.