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Lin H, Tian S, Niu C, Shen X, Wang M, Wan C, Shi B, Chen H, He M, Bai C, Huang H. A case of congenital bronchial atresia with tracheobronchial stenosis caused by emphysema: Successful management with thoracoscopic surgery. Heliyon 2024; 10:e32753. [PMID: 38912456 PMCID: PMC11193005 DOI: 10.1016/j.heliyon.2024.e32753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/04/2024] [Accepted: 06/07/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Congenital bronchial atresia (CBA), as a rare developmental abnormality of the lung, is usually asymptomatic and is accidently discovered in most cases. Currently, no standardized guidelines for the treatment or management of CBA have been established. Case presentation A 22-year-old male soldier was referred to Shanghai Changhai Hospital, The First Affiliated Hospital of Naval Medical University due to chest tightness and shortness of breath after repeated strenuous activities. Contrast-enhanced computed tomography (CT) revealed an 18mm × 11mm solitary, well-circumscribed, and solid nodule with no enhancement in the right upper lobe (RUL), and emphysematous changes distributed throughout the RUL. A flexible bronchoscopic examination showed extrinsic compression stenosis in the bronchial opening of the right middle lobe (RML). After three-dimensional (3D) reconstruction CT and a multidisciplinary consultation, a diagnosis of CBA in the anterior segment (B3) of RUL was established. Subsequently, thoracoscopic right upper lobectomy was performed and resulted in an improved respiratory capacity 6 months after surgery. To date, the patient has good quality of life without any complication. Conclusion This study underscores the role of bronchoscopy, 3D reconstruction CT, and a multidisciplinary consultation in the diagnosis of CBA, and highlights that a thoracoscopic intervention should be considered in such case.
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Affiliation(s)
- Huan Lin
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Sen Tian
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Department of Respiratory and Critical Care Medicine, No. 906 Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Ningbo, China
| | - Chunlai Niu
- Department of Rehabilitation Medicine, The Second Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Xiaping Shen
- Department of Radiology, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Mingming Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Department of Respiratory and Critical Care Medicine, The Second People's Hospital of Fuyang City, Fuyang, Anhui, China
| | - Changhong Wan
- Department of Chest, Lung and Breast Surgery, Clifford Hospital, Guangzhou, Guangdong, China
| | - Bowen Shi
- Department of Thoracic Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Hezhong Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Miaoxia He
- Department of Pathology, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Chong Bai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Haidong Huang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Naval Medical University, Shanghai, China
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Sumiya R, Nagasaka S, Ikeda T, Suyama Y, Miyazaki H. Complete thoracoscopic surgery for extensive emphysema in the right upper and middle lobes caused by right B5 bronchial atresia. J Surg Case Rep 2021; 2021:rjab484. [PMID: 34729173 PMCID: PMC8557331 DOI: 10.1093/jscr/rjab484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/05/2021] [Indexed: 11/27/2022] Open
Abstract
Bronchial atresia is a rare congenital condition that may lead to infectious complications. Almost all patients with this condition are diagnosed early in life with normal lungs, making them particularly suitable candidates for thoracoscopic surgery. A 30-year-old man was referred to our hospital due to an abnormal shadow on chest radiography taken 7 years prior. Despite being diagnosed with B5 bronchial atresia, he refused to undergo surgical resection. Seven years later, he developed right chest pain. Computed tomography showed B5 bronchial occlusion, mucoid impaction and emphysematous changes. Treatment with thoracoscopic right middle lobectomy and S3 partial resection using four ports resulted in good lung expansion after discharge. This study highlights that thoracoscopic surgical resection should be considered in patients with bronchial atresia.
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Affiliation(s)
- Ryusuke Sumiya
- Department of General Thoracic Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Satoshi Nagasaka
- Department of General Thoracic Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takeshi Ikeda
- Department of General Thoracic Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yuto Suyama
- Department of General Thoracic Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hideki Miyazaki
- Pathology Division of Clinical Laboratory, National Center for Global Health and Medicine, Tokyo, Japan
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Ceylan KC, Batihan G, Üçvet A, Gürsoy S. Surgery in congenital lung malformations: the evolution from thoracotomy to VATS, 10-year experience in a single center. J Cardiothorac Surg 2021; 16:131. [PMID: 34001173 PMCID: PMC8130166 DOI: 10.1186/s13019-021-01511-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/05/2021] [Indexed: 11/25/2022] Open
Abstract
Background Congenital lung malformation is an umbrella term and consist of various kind of parenchymal and mediastinal pathologies. Surgical resection is often required for diagnosis and curative treatment. We aimed to review our experience in surgical treatment for congenital lung disease and present the role of minimally invasive surgery. Methods Surgical resections performed for benign lesions of the lung and mediastinum between January 2009 and May 2019 were retrospectively analyzed. Patients who were found to have congenital lung malformation as a result of pathological examination were included in our study. Distribution characteristics of the patients according to congenital lung malformation subtypes, differences in surgical approach and postoperative results were investigated. Results A total of 94 patients who underwent surgical resection and were diagnosed with the bronchogenic cyst, sequestration, bronchial atresia, congenital cystic adenomatoid malformation (CCAM), or enteric cyst as a result of pathological examination were included the study. There were no significant differences between pathological subtypes in the postoperative length of hospital stay and drainage duration however, perioperative complication rate was higher in the sequestration group. In addition, in the first three days postoperatively, the mean pain score was found to be lower in the VATS group compared to thoracotomy. Conclusions Congenital lung malformations consist of a heterogeneous group of diseases and the surgical treatment in these patients can range from a simple cyst excision to pneumonectomy. Video-assisted thoracoscopic surgery should be considered as the first choice in the surgical treatment of these patients in experienced centers.
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Affiliation(s)
- Kenan C Ceylan
- Department of Thoracic Surgery, University of Health Sciences Dr Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital Izmir, 35110, Yenişehir, Gaziler Street, 331, Izmir, Turkey
| | - Güntuğ Batihan
- Department of Thoracic Surgery, University of Health Sciences Dr Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital Izmir, 35110, Yenişehir, Gaziler Street, 331, Izmir, Turkey.
| | - Ahmet Üçvet
- Department of Thoracic Surgery, University of Health Sciences Dr Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital Izmir, 35110, Yenişehir, Gaziler Street, 331, Izmir, Turkey
| | - Soner Gürsoy
- Department of Thoracic Surgery, University of Health Sciences Dr Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital Izmir, 35110, Yenişehir, Gaziler Street, 331, Izmir, Turkey
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Hasenauer A, Forster C, Ojanguren A, Gonzalez M. Complex congenital lung malformation resection by uniportal VATS—case report. J Surg Case Rep 2021; 2021:rjab069. [PMID: 35070259 PMCID: PMC8777473 DOI: 10.1093/jscr/rjab069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/08/2021] [Indexed: 11/15/2022] Open
Abstract
Bronchial atresia (BA) is a rare congenital pulmonary airway malformation. It is characterized by the focal stenosis of a proximal segmental bronchus associated with peripheral mucus impaction and hyperinflation of the obstructed lung segment. Most cases are identified during neonatal period or childhood. When diagnosed in adults, BA may present with recurrent infections, pneumothorax and destruction of affected parenchyma. Thoracoscopic approach to BA has proved challenging in adult patients because of repeated infections and subsequently, its inflammatory status. Herein we present a case of a 26-year-old female with left side recurrent pneumonia and pneumothorax past history. A chest computed tomography revealed a complex congenital bronchial atresia involving the left upper lobe and basal segments, associated to vascular anomalies. She underwent a successful uniportal VATS left upper lobectomy and resection of basal segments. Uniportal VATS approach is an effective and safe treatment for the management of complex congenital lung malformation.
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Affiliation(s)
- Arpad Hasenauer
- Service of Thoracic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Céline Forster
- Service of Thoracic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Amaya Ojanguren
- Service of Thoracic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Michel Gonzalez
- Service of Thoracic Surgery, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
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Puglia EBMD, Rodrigues RS, Daltro PA, Souza AS, Paschoal MM, Labrunie EM, Irion KL, Hochhegger B, Zanetti G, Marchiori E. Tomographic findings in bronchial atresia. Radiol Bras 2021; 54:9-14. [PMID: 33574627 PMCID: PMC7863713 DOI: 10.1590/0100-3984.2019.0136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective To evaluate computed tomography (CT) findings in 23 patients with bronchial atresia. Materials and Methods The CT images were reviewed by two radiologists who reached decisions by consensus. We included only patients who presented with abnormalities on CT and in whom the diagnosis had been confirmed by pathological examination of the surgical specimen (if the lesion was resected). The CT scans were assessed in order to identify the main findings and to map the distribution of the lesions (i.e., to determine whether the pulmonary involvement was unilateral or bilateral). Results The main CT finding was the combination of bronchocele and hyperinflation of the distal lung. That combination was observed in all of the patients. The lesions were unilateral in all 23 cases, being seen predominantly in the left upper lobe, followed by the right lower lobe, right upper lobe, middle lobe, and left lower lobe. Conclusion The diagnosis of bronchial atresia can be reliably made on the basis of a finding of bronchocele accompanied by hyperinflation of the adjacent lung parenchyma.
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Affiliation(s)
- Elazir Barbosa Mota Di Puglia
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.,Clínica de Diagnóstico por Imagem (CDPI), Rio de Janeiro, RJ, Brazil
| | - Rosana Souza Rodrigues
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.,Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ, Brazil
| | | | - Arthur Soares Souza
- Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, SP, Brazil
| | | | | | | | - Bruno Hochhegger
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Gláucia Zanetti
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Murata S, Oguri T, Sasada S, Tsuchiya Y, Ishioka K, Takahashi S, Kuriyama S, Kaji M, Seki R, Hirose S, Nakamura M. A case of congenital bronchial atresia patient with subclinical infection who underwent lung resection. Respir Med Case Rep 2020; 30:101076. [PMID: 32420019 PMCID: PMC7218211 DOI: 10.1016/j.rmcr.2020.101076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 05/05/2020] [Indexed: 11/17/2022] Open
Abstract
Congenital bronchial atresia, CBA, is rare and has often asymptomatic benign condition. The CBA condition usually arose during the formation of bronchi, but the CBA patients are able to live well into adulthood. This case highlights a potential surgical intervention for a CBA patient with subclinical infection. A 55-year-old Japanese male had abnormal findings on his chest X-ray at an annual health check-up in March 2018. His chest computed tomography (CT) revealed bronchial stenosis and infiltrative shadow in the right inferior lobe. He was referred to our hospital for further investigation and was diagnosed CBA after a variety of examinations including bronchoscopy. His dilated bronchi were filled with mucus, the end of one of the bronchi had obstructive pneumonia, and subclinical infection in the CBA lesion was suspected. Also, the result of bronchoscopy disclosed intrabronchial infection with Gram-positive bacteria so we performed lobectomy onto the lower lobe. Although no protocol had been established, a surgical intervention would be necessary for this case.
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Affiliation(s)
- Saori Murata
- Department of Respiratory Medicine, Tokyo Saiseikai Central Hospital, Japan
| | - Tomoyo Oguri
- Department of Respiratory Medicine, Tokyo Saiseikai Central Hospital, Japan
| | - Shinji Sasada
- Department of Respiratory Medicine, Tokyo Saiseikai Central Hospital, Japan
| | - Yumi Tsuchiya
- Department of Respiratory Medicine, Tokyo Saiseikai Central Hospital, Japan
| | - Kota Ishioka
- Department of Respiratory Medicine, Tokyo Saiseikai Central Hospital, Japan
| | - Saeko Takahashi
- Department of Respiratory Medicine, Tokyo Saiseikai Central Hospital, Japan
| | - Shoji Kuriyama
- Department of Thoracic Surgery, Tokyo Saiseikai Central Hospital, Japan
| | - Masahiro Kaji
- Department of Thoracic Surgery, Tokyo Saiseikai Central Hospital, Japan
| | - Reishi Seki
- Department of Diagnostic Pathology, Tokyo Saiseikai Central Hospital, Japan
| | - Shigemichi Hirose
- Department of Diagnostic Pathology, Tokyo Saiseikai Central Hospital, Japan
| | - Morio Nakamura
- Department of Respiratory Medicine, Tokyo Saiseikai Central Hospital, Japan
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Nair VV, Narayan KV, Nair JTK. "Not all bullae are synonymous with COPD"-a rare congenital anomaly described. Indian J Thorac Cardiovasc Surg 2019; 35:89-90. [PMID: 33060980 DOI: 10.1007/s12055-018-0715-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 07/04/2018] [Accepted: 07/16/2018] [Indexed: 11/28/2022] Open
Abstract
Hyperlucent areas with thin walls and absent vascular markings in chest X ray are described as radiological findings of a bullae. We present the case of an adult male referred for coronary revascularisation and bullectomy in the right lung. A non-smoker, without any significant past medical history, made us think of bronchial atresia. He was planned for coronary artery bypass grafting with close follow-up of lung anomaly. Clinicians should be aware of this entity in non-smokers with unilateral bullous lesion and calcification as other close clinical differentials warrant aggressive medical management.
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