Bronchial atresia associated with epibronchial right pulmonary artery and aberrant right middle lobe artery

Magnetic resonance imaging of pediatric lung parenchyma, airways, vasculature, ventilation, and perfusion: state of the art

Magnetic resonance (MR) imaging is a noninvasive imaging modality, particularly attractive for pediatric patients given its lack of ionizing radiation. Despite many advantages, the physical properties of the lung (inherent low signal-to-noise ratio, magnetic susceptibility differences at lung-air interfaces, and respiratory and cardiac motion) have posed technical challenges that have limited the use of MR imaging in the evaluation of thoracic disease in the past. However, recent advances in MR imaging techniques have overcome many of these challenges. This article discusses these advances in MR imaging techniques and their potential role in the evaluation of thoracic disorders in pediatric patients.

Prenatal diagnosis of main stem bronchial atresia using 3-dimensional ultrasonographic technologies

OBJECTIVE

The purpose of this series was to report the contribution of 3-dimensional ultrasonographic (3DUS) technologies in performing the prenatal diagnosis of main stem bronchial atresia (BA).

METHODS

We report 2 cases in which the prenatal diagnosis of main stem BA was performed using 3DUS technologies. Both fetuses presented with extremely enlarged hyperechoic right lungs, shifting the mediastinum to the left, associated with hydrops and polyhydramnios. A revision of the literature was made, focusing on the prenatal characteristics and perinatal prognosis of main stem BA.

RESULTS

In the first case, a congenital type III cystic adenomatoid malformation was suspected initially, but a posterior 3DUS analysis on multiplanar imaging allowed identification of a dilated right bronchus, and a right main stem BA was confirmed at autopsy. In the second case, volume contrast imaging was used during fetal scanning, which also allowed identification of the right main bronchial dilatation. In reviewing the literature, we found a tendency for main stem BA to be more severe than lobar and segmental atresias.

CONCLUSIONS

Three-dimensional ultrasonographic technologies may improve the pre-natal diagnosis of main stem BA.

Congenital abnormalities of intrathoracic airways

Multidetector CT has broadened the potential of imaging to demonstrate anomalies of the lung and the tracheobronchial tree with increasing frequency. Two-and three-dimensional reformatting improve the understanding of complex tracheobronchial anomalies. Most congenital tracheobronchial anomalies are rare and almost always nonsymptomatic; however, some may be confused with or even responsible for respiratory disease. Tracheal and accessory cardiac bronchi are among the most frequent anomalies, but other ectopic or supernumerary lung buds, developmental tracheobronchial interruption, obstruction, or compression, communicating bronchopulmonary foregut malformations, and bronchial malformations associated with anomalies of situs can be detected, even late after birth.

Congenital Bronchial Atresia Associated With Spontaneous Pneumothorax

A 36-year-old woman presented with left chest pain and frequent symptoms of upper respiratory infection. Chest roentgenograms revealed a left pneumothorax and apical bulla, and hyperlucency in the left pulmonary field. She was diagnosed with congenital bronchial atresia associated with a left spontaneous pneumothorax. A thoracoscopy-assisted left superior segmentectomy was performed. There was no recurrence of the pneumothorax or symptoms of recurrent upper respiratory infection at the 1-year follow-up examination. Bulla formation was believed to have resulted from emphysematous changes in the peripheral lung due to congenital bronchial atresia. The pneumothorax may have occurred due to rupture of the bulla.

Bronchial atresia of the right lower lobe

Bronchial atresia (BA) is a rare congenital anomaly that is found incidentally in approximately 50% of cases. It predominantly affects young men and generally produces no symptoms. The other 50% of cases have pulmonary symptoms such as fever, cough, or shortness of breath due to recurrent pulmonary infection or overinflation of the involved lung parenchyma. The most common site is the left upper lobe, particularly of the apical-posterior segment. The right lower and middle lobes are affected in only 8% of cases. The radiographic features may be highly suggestive of the diagnosis. The mucus-filled bronchus is seen as a rounded, branching opacity emanating from the hilum and is surrounded by an area of increased hyper-translucency. We report an unusual presentation of BA in a 43-year-old woman with a history of recurrent pulmonary infection and dyspnea. The patient was found to have BA in all the basal segments of the lower lobe of the right lung.

Aspectos radiológicos da atresia brônquica: relato de três casos e revisão da literatura

A atresia brônquica é uma anomalia congênita rara que usualmente produz massa justa-hilar com hipertransparência distal à radiografia simples. A maioria dos pacientes é jovem e não apresenta sintomas. A tomografia computadorizada confirma o diagnóstico, permitindo o manejo conservador nos casos assintomáticos. Os autores relatam três casos de atresia brônquica. Um caso, de particular interesse, estava associado a volumosa broncocele em paciente do sexo feminino, de 45 anos de idade, que apresentou quadro sintomático de infecção respiratória. O diagnóstico foi estabelecido por meio dos achados da radiologia convencional, da tomografia computadorizada e da comparação com radiografias convencionais e tomografia linear prévios, que já demonstravam alterações. Realizou-se uma revisão sobre os achados clínicos e radiológicos dessa malformação.

Congenital bronchial atresia: radiologic findings in nine patients

PURPOSE

The purpose of this article is to describe the radiologic findings to diagnose congenital bronchial atresia.

METHODS

Chest radiographs, CT scans, and MRI of nine patients with congenital bronchial atresia were reviewed.

RESULTS

Six patients (67%) had hilar mass-like shadows and hyperlucency of the peripheral lung field on chest radiographs. On chest CT scans, all patients demonstrated mucocele, occlusion of bronchus central to mucocele, and emphysematous change of the peripheral lung field. On chest MRI, performed in seven patients, all mucoceles demonstrated very high signal intensity on T2-weighted image, indicating that mucoceles were filled with fluid.

CONCLUSION

Diagnosis of congenital bronchial atresia can be confirmed based on the findings of chest CT: mucocele, occlusion of bronchus central to mucocele, and emphysematous change of the peripheral lung field.

Congenital bronchial atresia--presentation of three cases and a pictorial review

Congenital bronchial atresia (CBA) is a rare anomaly that results from a congenital focal obliteration of a proximal segmental or subsegmental bronchus with the normal development of distal structures. The short atretic segment leads to accumulation of mucus within the distal bronchi to form a bronchocoele and underventilation of the affected part of the lung. The clinical and radiographic features of three cases of CBA are reported and the literature is reviewed. Radiologically, CBA is characterized by the presence of a branching opacity, the bronchocoele, radiating from the hilum surrounded by an area of hyperlucency. These features can be recognized on the chest radiograph but are more clearly defined by computed tomography. Fibreoptic bronchoscopy (FOB) is often required to exclude acquired proximal bronchial obstruction by tumour, foreign body or inflammatory stricture. In CBA a blind-ending bronchus may be revealed, although FOB is often normal. Bronchographic examination is generally abnormal but the appearances may be confusing and is rarely performed. Pathologically, CBA is characterized by a blind-ending bronchus associated with dilated distal bronchi containing impacted mucus. The surrounding lung parenchyma is hyperinflated due to collateral air drift. CBA can be identified accurately by imaging techniques which may make surgery unnecessary in asymptomatic cases.