Bronchial Atresia

Lee A Fox, MD
Andetta Hunsaker, MD

June 10, 1997

Presentation

Imaging Findings

Posteroanterior (PA) and lateral views of the chest demonstrate well-expanded lungs with no pleural effusion. There is a somewhat tortuous nodular opacity in the left lower lobe (arrows). Pulmonary vessels appear to extend to this area.

Axial images from an intravenous contrast-enhanced computed tomography (CT) examination demonstrate a tubular branching opacity in the left lower lobe (arrow). The opacity has no identifiable connection with the adjacent vascular structures. It does not extend to the hilum. The mass is surrounded by an area of extensive hyperlucent lung parenchyma (arrows). No other pulmonary masses are visible.

Diagnosis

Discussion

Bronchial atresia is a pulmonary anomaly of unknown etiology in which a segmental bronchus does not communicate with the central airways. It is believed by some to represent the sequela of vascular insult to the lung parenchyma during early fetal development (at approximately 15-16 wks gestation). Another theory suggests that bronchial atresia occurs secondary to separation of the bronchial bud during the 5-6th week of gestation. This may explain why bronchial atresia can coexist with pulmonary sequestration and bronchogenic cysts, which also form during this period of development.

A majority (58%) of patients with bronchial atresia are asymptomatic. In these cases, the mass is identified as an incidental finding on a routine chest radiograph. Most are noted in young patients and there is a female predominance (female:male, 2:1). Physical examination may reveal decreased breath sounds over the affected portion of lung. Symptomatic patients usually present with recurrent chest infections, dyspnea, wheezing, or chronic cough.

Bronchial atresia usually involves a segmental bronchus and is most commonly found in the apical posterior segment of the left upper lobe. The left lower lobe is the second most common location followed by the right middle lobe.

Classic findings on chest radiographs include a branching, tubular mass (representing mucoid impaction of a bronchus) surrounded by hyperinflated lung with decreased vascular markings. If the hyperinflation is not fully appreciated or if the mass appears more linear, the diagnosis of bronchial atresia is more difficult to make. The mucocele in bronchial atresia may be misinterpreted as an arteriovenous malformation, granuloma, or even a metastatic lesion.

Computed tomography is the study of choice for the diagnosis of bronchial atresia. CT easily identifies the segmental emphysematous changes distal to the mucoid impacted bronchus. The branching structure seen on CT often points toward the hilum.

Treatment usually consists of conservative management. In symptomatic cases complicated by recurrent infection or respiratory compromise, surgical resection may be indicated.

References

2. Rappaport DC, Herman SJ, Weisbrod GL. Congenital bronchopulmonary diseases in adults: CT findings. American Journal of Roetgenology, 1994;162: 1295-99.

3. Kinsella D, Sissons G, Williams MP. The radiological imaging of bronchial atresia.British Journal of Radiology 1992;65:681-85.

4. Shady K, Siegel MJ, Glazer HS. CT of focal pulmonary masses in childhood. Radiographics, 1992;12:505-514.

5. Kuhn C, Kuhn JP. Coexistence of bronchial atresia and bronchogenic cyst: Diagnostic criteria and embryologic considerations. Pediatric Radiology 1992;22:568-70.

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