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.2012;9(3):207-12.
doi: 10.7150/ijms.3690. Epub 2012 Mar 3.

Congenital bronchial atresia: diagnosis and treatment

Affiliations

Congenital bronchial atresia: diagnosis and treatment

Yuqi Wang et al. Int J Med Sci.2012.

Abstract

This study aimed to retrospectively summarize the clinical signs, diagnosis, and treatment of congenital bronchial atresia (CBA) in 12 patients. Chest radiographs and computed tomographic (CT) images of 12 patients with CBA treated in the Chinese People's Liberation Army General Hospital were reviewed. Analysis of chest radiographs revealed ten patients had hilar mass-like shadows and two had pneumonia-like shadows; most patients (n = 8) showed hyperlucency of the peripheral lung fields. CT revealed a mucocele in all the patients (n = 12); the mucoceles were round in four patients and club-like in eight. In 80% of the cases (n = 10), associated anomalies, including occlusions of the bronchus central to the mucocele, emphysematous changes of the peripheral lung fields, bronchogenic cyst, and anomalous branching of the bronchial tree and vascular structure were observed. CBA was detected in the right lobe in eight patients and the left lobe in the remaining four. No surgical intervention was performed in 5 CBA patients and the remaining 7 patients underwent surgery, including lobectomy in 5 patients and local resection in 2 patients. Among these 7 patients, 3 had a preoperative diagnosis of malignant disease, and the remaining 4 had severe clinical symptoms that could not be effectively treated by medicines. All patients were followed up, and none experienced obvious discomfort. CBA is a relatively rare and benign malformation disease. Chest CT is the procedure of choice for diagnosis. The presence of a bronchocele and surrounding emphysematous changes are typical radiologic findings in CBA. Surgery should be reserved only for patients with serious complications secondary to the atretic bronchus.

Keywords: bronchial atresia; diagnosis; lung; surgical treatment.

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Conflict of interest statement

Conflict of Interest: The authors have declared that no conflict of interest exists.

Figures

Figure 1
Figure 1
A 54-year-old male with a pulmonary lesion identified on a routing chest computed tomographic scan. Axial lung window (A), axial soft-tissue window (B), and minimum-intensity-projection (MinIP) lung window coronal (C), and sagittal (D) contrast-enhanced CT images show a dilated, club-like structure surrounded by emphysematous changes of the peripheral lung fields at the superior segment of the left lower lobe; computerized tomography number is 28 HU; non-enhancement of the structure is shown on contrast-enhanced CT. The orifice of the superior segmental bronchus was not observed. CT features indicate a diagnosis of bronchial atresia. E, F, G, H are the corresponding normal control CT findings of A.B, C, D.
Figure 2
Figure 2
Bronchoscopy. A, complete obstruction of the orifice of the left B6. B, normal structure from bronchoscopic examination.
Figure 3
Figure 3
Photomicrograph (original magnification, ×100; hematoxylin-eosin staining) reveals the following: (A) the bronchioles plugged by mucus and the surrounding alveoli are dilated. Many neutrophils and macrophages were found within the bronchi and surrounding lung parenchyma, indicating acute or chronic infection. (B) Alveoli were enlarged, with a loss of alveolar walls. (C, D): structure of alveoli and mucus accumulation in the bronchioles(200X); (E) HE staining of normal lung.
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