October 30, 2010

Bronchial Atresia

Chest radiograph shows a well circumscribed tubular mass in the left upper lobe with distal localized emphysema in a 41-year-old asymptomatic patient.
Coronal-reformatted CT image demonstrate the mass to be a dilated segment of left upper lobe bronchus filled with mucus. Localized emphysema in the left upper lobe is confirmed.

Facts: Bronchial Atresia
  • Absence of communication between a segment or subsegmental bronchus and the central airways.
  • Most cases are found incidentally on imaging (asymptomatic)
  • Most common location = apical posterior segment of the left upper lobe.
Imaging Features
  • Mucus plug surrounded by hyperlucent lung.
  • Absence of enhancement (enhanced CT and/or endoscopic examination may be required to exclude an endoluminal obstructing lesion)
  • Absence of communication with pulmonary vessels

Differential Diagnosis
  • Mucous plug distal to bronchial obstruction (endobronchial neoplasm, for example)
  • Focal bronchiectasis with mucus plugging
  • Pulmonary sequestration
  • Allergic bronchopulmonary aspergillosis
  • Vascular malformation
Parker MS, Rosado de Christenson ML, Abbott GF. Teaching Atlas of Chest Imaging, 2005.

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