Presentation
Chronic cough.
Patient Data
Chest x-ray shows a hyper lucent left upper lobe with paucity of vascularity and a short, tubular density in the left supra hilar region.
Non contrast CT of the chest shows a hyper lucent left upper lobe with blind-ending (atretic) bronchi with proximal intraluminal mucous plugging.
VQ scan:
Perfusion: complete absence of perfusion in the left upper lobe
Ventilation: posterior view shows a complete absence of radiotracer in the left upper lobe on inspiration, but subsequent fill-in on equilibrium and trapping on washout
Case Discussion
Bronchial atresia is a congenital disorder that is due to the abnormal development of a bronchus, where there is focal obliteration of the airway and hyperinflation of the distal lung. It most commonly involves the left upper lobe, as in this case, followed by the right upper and middle lobes.
Patients are usually asymptomatic, and the abnormality is incidentally discovered on chest imaging performed for some other reason. Less commonly, patients may complain of mild respiratory symptoms such as chronic cough or recurrent infections.
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