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Chest Imaging

Bronchial atresia

loss of continuity of a bronchus usually at the segmental level. The bronchus is blind on its hilar aspect. The interruption is short. Beyond the defect the bronchial tree branches normally down to the alveoli. The lung is ventilated by collateral air drift. Bronchocoeles appear beyond the atresia. Associated with overinflation as a consequence of cross-ventilation, this anomaly is often called "bronchocoele-overinflation syndrome" (see mucoid impaction (V:1), Fig. 1). The left upper lobe is the usual site, almost invariably the apical or apicoposterior segments (Fig.1). The diagnosis is easily assessed by chest radiography (Fig. 1) and CT scan showing bronchocoeles with or without branching configuration, overinflation with air trapping and hypoperfusion (overinflation (V:1), Fig. 2). A congenital origin is presumed in neonatal cases, but an acquired origin has to be excluded. Overinflation of the left upper lobe can be seen in three circumstances: bronchial atresia, stenosed tracheal bronchus, and bronchogenic cyst hidden in the aortic arch concavity. Other congenital thoracic anomalies may be associated with bronchial atresia: pericardial defects, atrial septal defect and left-sided inferior vena cava, congenital cystic adenomatoid malformation Stocker type III, anomalous venous drainage of the left upper lobe and sequestration.

JR - MRJ

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Fig.1

Segmental bronchial atresia of the left upper lobe. Hyperlucent left hemithorax. The left hilar mass suspected of being a bronchogenic cyst corresponds to a congenital defect of the left pericardium.
Bronchial atresia, Fig.1