Prenatal and postnatal management of congenital bronchial atresia (CBA): single tertiary center report

A single institution's experience with the management of peripheral bronchial atresia

PURPOSE

Peripheral bronchial atresia is a pulmonary abnormality diagnosed on postnatal computed tomography after prenatal imaging reveals a congenital lung lesion. Debate regarding management of this abnormality prompted us to review our institution's practice patterns and outcomes.

METHODS

All patients diagnosed with bronchial atresia were assessed from 6/2014 to 7/2020. Pediatric radiologists were surveyed to delineate computed tomography criteria used to diagnose peripheral bronchial atresia. Criteria were applied in an independent blinded review of postnatal imaging. Data for patients determined to have peripheral bronchial atresia and at least an initial pediatric surgical evaluation were analyzed.

RESULTS

Twenty-eight patients with bronchial atresia received at least an initial pediatric surgical evaluation. Expectant management was planned for 22/28 (79%) patients. Two patients transitioned from an expectant management strategy to an operative strategy for recurrent respiratory infections; final pathology revealed bronchial atresia in both. Six patients were initially managed operatively; final pathology revealed bronchial atresia (n = 3) or congenital lobar overinflation (n = 3).

CONCLUSIONS

Peripheral bronchial atresia can be safely managed expectantly. A change in symptoms is suspicious for alternate lung pathology, warranting further workup and consideration for resection.

LEVEL OF EVIDENCE

Level IV.

Unmasking of left upper lobe bronchial atresia in a case of H1N1 pneumonia

We describe a case of H1N1 pneumonia with left upper lobe bronchial atresia. Although bronchial atresia as an isolated occurrence is an innocuous finding, but when it is superimposed by another major insult, it can amplify the disease effect and can have adverse implications leading to significant morbidity. This report highlights the fact that anatomical anomalies can be the cause of inordinately severe or prolonged course of acute respiratory infection in children.