Fetal Congenital Peripheral Bronchial Atresia Diagnosed by Magnetic Resonance Imaging: Two Case Reports

Abstract

Two types of congenital bronchial atresia (proximal and peripheral) have been classified. We report two cases of peripheral bronchial atresia diagnosed by prenatal ultrasonography (US) and magnetic resonance imaging (MRI). Evaluating an enlarged lung mass that is homogeneously hyperechoic on US and hyperintense on T2-weighted MRI can help in determining whether bronchial atresia is present. Proximal type is suggested when a dilated main bronchus is observed as a tubule structure of an involved lung hilum. In our cases, T2-weighted MRI revealed homogeneously hyperintense lung lesion with decreased signal intensity of adjacent lobe, flattening diaphragm, and mediastinal shift. Dilatation of the main bronchus was not observed and the opposite lung was normal in appearance. These findings were explained by secondary compression due to enlargement of the involved lung. The preservation of vascular structure and the retained normal shape, though enlarged, in the affected lobe were observed, which demonstrated undisrupted pulmonary architecture of the lobe. Thus, congenital cystic adenomatoid malformation was excluded because pulmonary architecture was relatively preserved. Finally, presumed diagnoses of the peripheral bronchial atresia were made and confirmed by postnatal chest computed tomography.

Atresia bronquial congénita: una serie de casos en población adulta colombiana

“…El primer caso fue descrito en 1853 por Ramsay. 3,4 El diagnóstico usualmente es incidental ya que alrededor del 50% de los pacientes son asintomáticos. En el estudio de Psathakis y colaboradores publicado en el 2004, se encontró que el tamizaje radiográfico en una población de hombres identificó 1,2 casos por/100,000.…”

“…En consulta de neumología presentó radiografía de tórax en la que se observó una lesión focal «en dedo de guante» en la región parahiliar derecha y alteraciones intersticiales mixtas apicales (figura 2). Se amplió estudio de dichos hallazgos con TAC de tórax y se observaron alteraciones intersticiales nodulares y tractos fibrosos apicales bilaterales, con lesión ovalada en segmento superior de lóbulo inferior derecho (LID) con densidad cálcica en su interior, de aspecto benigno y, adicionalmente, atenuación en mosaico generalizada (figuras [3][4][5]. Durante la consulta no mencionó historia de tuberculosis pulmonar o contacto con sintomáticos respiratorios.…”

Ultrasound Differential Diagnosis and Prognosis of Right Main Bronchus Atresia in Fetus: Clinical Case

“…Прогноз для жизни ребенка зависит от уровня атрезии. Долевая и сегментарная обструкция распространяются лишь на небольшой объем легкого и обычно почти не имеют клинических последствий [2]. Односторонняя атрезия главного бронха характеризуется крайне неблагоприятными перинатальными исходами.…”

“…Мы считаем, что увеличение в объеме пораженной части легкого нехарактерно для секвестрации, так же как и наличие гипоэхогенных линейных трубчатых структур в паренхиме увеличенного в объеме легкого. В пренатальном периоде во II триместре беременности дыхательные пути дистальнее обструкции расширяются и заполняются жидкостью [2], что обусловливает появление этих трубчатых структур. Использование высокочастотных линейных датчиков, как и в нашем исследовании, позволяет более детально изучить легкое, в т.ч.…”

Congenital Central Overinflation with Mainstem Bronchial Stenosis: Pre- and Postnatal Imaging and Outcome—Case Report and Brief Review of Literature

“…Prenatal detection of an enlarged echogenic/hyperintense lung on ultrasound or magnetic resonance imaging (MRI) comprises of various differentials like congenital overinflation (CO), bronchial atresia (BA), congenital pulmonary airway disease (CPAM), bronchopulmonary sequestration (BPS), and congenital high airway obstruction syndrome (CHAOS). 1 2 Imaging features of CPAM and BPS are well documented, however, there is sparse literature about the prenatal imaging findings of CO. CO is overdistention of alveoli without any parenchymal destruction secondary to bronchial obstruction, from any cause. CO has an incidence rate of 1 in 20,000 to 30,000 live births.…”