Allergy and Airway |

An Unusual "Lung Mass" FREE TO VIEW

Thomas Waring, MD; Danae Delivanis, MD; Anat Bergner, MD; E. Kaloudis, MD; D. Datta, MD
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University of CT Health Center, Farmington, CT

Chest. 2013;144(4_MeetingAbstracts):1A. doi:10.1378/chest.1675132
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SESSION TITLE: Airway Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 29, 2013 at 01:30 PM - 02:30 PM

INTRODUCTION: Bronchial atresia (BA) is a rare congenital abnormality of the tracheobronchial tree. We report a case of a 47-year old female incidentally found with this condition.

CASE PRESENTATION: The patient, a non-smoker with a history of asthma, presented with difficulty breathing. She was on inhaled bronchodilators for her asthma which was not well-controlled. No history of fevers, chronic cough, hemoptysis, weight loss or environmental or occupational exposures was present. Examination was unremarkable. Lungs were clear to auscultation. Cardiac examination was normal. Chest x-ray revealed two circumscribed masses in her right upper lobe (Image 1). A Computerized Tomogram(CT)-guided needle biopsy was planned. However, on CT chest, the masses appeared to have a fluid attenuation and were peripherally distributed with localized hyperlucency distal to the mass (Image 2). The mass-like lesions represented the obstructed bronchus, dilated due to mucus impaction, with localized area of hyperinflation manifest as increased lucency distal to the lesion.Bronchial atresia (BA) was diagnosed based upon these characteristic CT findings. The patient was treated with bronchodilators and inhaled corticosteroids, with improvement in her asthma symptoms. On follow-up 6 months later, the patient is doing well without any sequelae.

DISCUSSION: BA, a rare congenital tracheobronchial anomaly, occurs predominantly in males. A vascular insult during embryogenesis has been implicated in its causation. It is characterized by a focal narrowing of a sub-segmental, segmental or lobar bronchus, associated with mucocele formation due to mucus impaction, and hyperinflation of the distal segment of lung. The alveoli supplied by the obstructed bronchi are ventilated via collateral airways, resulting in air-trapping and localized hyperinflation.Most patients are asymptomatic with about 30% experiencing recurrent respiratory infections, cough, dyspnea or haemoptysis. At present, BA is usually diagnosed by CT. Bronchoscopy may be non-diagnostic but maybe required in cases where similar findings on CT can be found, such as lung cancer or bronchial adenoma.Tissue biopsy is not essential for diagnosis, if characteristic CT features are present. Management is conservative unless there is a superimposed infection of the mucocele. Surgical excision is generally reserved for patients with recurrent infections.

CONCLUSIONS: BA is a rare congenital tracheo-bronchial malformation. If CT chest shows characteristic findings, tissue biopsy is not required for diagnosis. Surgery is required when complications such as encroachment of normal lung tissue or recurrent infections occur.

Reference #1: Mori M et al: Bronchial Atresia: Report of a Case and Review of the Literature.Surgery Today1993. 23:449-454.

Reference #2: Ramsey BH et al: Mycocele, congenital bronchiectasis and bronchogenic cyst. J Thorac Surg 1953, 26:21-29.

Reference #3: Zylak CJ et al: Developmental Lung Anomalies. Radiographics 2002; 22:S25-43.

DISCLOSURE: The following authors have nothing to disclose: Thomas Waring, Danae Delivanis, Anat Bergner, E. Kaloudis, D. Datta

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