Imaging: Fellow Case Report Poster - Imaging |

A Rare Cause of Solitary Pulmonary Nodule FREE TO VIEW

Surya Sreeram Palakuru, MD; Robert Lodato, MD
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University of Texas Health Science Center at Houston, Houston, TX

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):651A. doi:10.1016/j.chest.2016.08.745
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SESSION TITLE: Fellow Case Report Poster - Imaging

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Solitary pulmonary nodules (SPN) are a common clinical problem and have both malignant (primary lung cancer, metastases) and benign (infection, arteriovenous malformations, benign tumors) causes.Their evaluation may have negative consequences including procedural complications, increased health care costs, and emotional strain on the patient and family. Some benign SPN can be diagnosed from imaging alone. We present a case of a rare etiology of one such benign SPN.

CASE PRESENTATION: A 65-year-old male former smoker with a history of diabetes mellitus and hypertension presented with persistent back pain. MRI of the spine showed an incidental 11 mm nodule in the right lung. He denied dyspnea, cough, hemoptysis, and weight loss. Chest CT showed a well circumscribed, round nodule in the posterior basal segment of the right lower lobe. The nodule was located centrally within a hyperlucent area of lung (Figure). These findings are characteristic of a bronchocele associated with congenital bronchial atresia.

DISCUSSION: A bronchocele, also called mucoid impaction, is a mucus-filled dilated bronchus surrounded by aerated lung. Congenital bronchial atresia is a rare developmental abnormality resulting from focal interruption of a lobar, segmental, or subsegmental bronchus with associated peripheral mucus impaction (bronchocele) and hyperinflation of the obstructed lung segment. It was first described in 1953 by BH Ramsay in cystic lung disease. Its incidence is unknown. A recent review found only 12 cases over a 20 year period. The etiology of bronchial atresia is unclear. Majority of the cases are diagnosed incidentally in asymptomatic patients. Symptomatic patients can present with dyspnea or cough and may develop recurrent pulmonary infections or pneumothorax. Characteristic CT findings include mucocele, occlusion of the bronchus central to the mucocele, and emphysematous changes peripherally. A blind-ending bronchus is noted on bronchoscopy. Differential diagnoses include AV malformation, bronchial cyst, intralobar sequestration. No treatment is necessary for asymptomatic patients. Surgical excision is offered for patients who develop complications.

CONCLUSIONS: Bronchocele, with its associated congenital bronchial atresia, is a rare benign cause of solitary pulmonary nodule, readily diagnosed by CT imaging.

Reference #1: Wang Y et al. Int J Med Sci. 2012;9(3):207-12.

DISCLOSURE: The following authors have nothing to disclose: Surya Sreeram Palakuru, Robert Lodato

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