Pulmonary Procedures |

Recurrent Pulmonary Infections: A Rare Case of Bronchial Atresia FREE TO VIEW

Jeffrey Albores, MD; William Go, MD; Joanne Bando, MD
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David Geffen School of Medicine at UCLA, Los Angeles, CA

Chest. 2014;146(4_MeetingAbstracts):757A. doi:10.1378/chest.1992062
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SESSION TITLE: Bronchology/Interventional Procedures Case Report Posters

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: Bronchial atresia (BA) is a rare congenital abnormality that can manifest with recurrent pulmonary infections.

CASE PRESENTATION: A 38-year-old man, non-smoker with history of longstanding asthma, presented with recurrent pulmonary infections for three years. He has had episodes of upper respiratory infection or pneumonia every few months manifest by weeks of persistent productive cough, left pleuritic chest pain, and fevers. On examination, SaO2 was 98% on ambient air and lungs were clear to auscultation. He had normal immunoglobulin levels. Pulmonary function test was normal. Chest x-ray showed hyperlucency and decreased vascularity of the left upper lobe lung. Chest CT showed absence of proximal left upper lobar bronchus, bronchocele distal to this, and hyperlucency of the left upper lobe consistent with BA of the left upper lobe. Bronchoscopy demonstrated non-visualization of the left upper lobe takeoff without evidence of an endobronchial lesion. The patient has been successfully managed with bronchodilators and airway mucus clearance methods and will be referred for left upper lobectomy should he develop persistent infections not amenable to medical therapy.

DISCUSSION: BA arises as a result of a vascular insult during gestation and occurs predominantly in males. It is characterized by focal narrowing of proximal bronchus associated with mucocele formation due to mucus impaction and hyperinflation of the distal lung segment. The alveoli supplied by the obstructed bronchi are ventilated via collateral airways resulting in air-trapping and localized hyperinflation. Typically BA is an incidental finding and patients are generally asymptomatic; however, recurrent infections can occur as a consequence of mucus impaction. Chest CT typically demonstrates a characteristic perihilar bronchocele and regional hyperinflation. Fiberoptic bronchoscopy should be performed to exclude an endobronchial tumor. Medical management is typically preventative. Patients with recurrent infectious symptoms can opt for a trial of bronchodilators and mucus clearance methods but worsening recurrent infections or significant impingement of the hyperinflated areas adjacent to the normal lung are general indications for surgery.

CONCLUSIONS: BA is rare but is in the differential diagnosis of patient presenting with an obstructive phenotype and recurrent pulmonary infections, especially suggested by asymmetric lung hyperlucency on imaging.

Reference #1: Barreiro, T.J. et al. Chest, 2009. 135(2): p. 550-3.

DISCLOSURE: The following authors have nothing to disclose: Jeffrey Albores, William Go, Joanne Bando

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