Surgery for congenital bronchial atresia

Abstract

A 22-year-old woman presented with a feeling of chest tightness. Chest computed tomography showed a dendritic shadow in the left segment 1 + 2c, surrounded by hyperlucent emphysematous changes. Bronchoscopy revealed loss of the orifice of bronchus 1 + 2c. Thus a diagnosis of bronchial atresia was made, and a left upper division segmentectomy was performed. Bronchial atresia should be considered in the differential diagnosis of young patients with an abnormal chest shadow. It can be diagnosed based on the characteristic imaging and bronchoscopic findings. Surgery is indicated for symptomatic bronchial atresia and can provide complete amelioration of the condition.

Conservative management of congenital bronchial atresia: The Bambino Gesù children's hospital experience

“…As with other CLMs, there is wide agreement that resection is appropriate for symptomatic CBA, 13 and that surgery is usually curative 13 . The symptoms and complications most frequently reported in the literature as caused by or associated with CBA are recurrent respiratory infection, 9,14–22 pneumothorax, 21,23,24 chest discomfort, 25 mediastinal shift, 26 and pulmonary hypertension 27 . Conversely, there are varying opinions about optimal management of asymptomatic CBA; in some institutions, surgery is considered the best first‐line treatment option 6,28–31 while in ours and others, nonoperative active surveillance is preferred 9,12,32 .…”

“…In our institution, CBA is not even considered an indication for surgery, although we do not exclude its appropriateness when recurrent and severe clinical manifestations (pneumonia, dyspnea, cough, haemoptysis) occur and when medical and other nonsurgical management is unsuccessful. The literature reports infrequent cases of symptomatic CBA in adults that eventually lead to surgical resection 9,14–25,27 …”

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

“…Usualmente, hay una arteria colateral anómala proveniente de la circulación sistémica. 1,2 Es una anomalía poco frecuente. El primer caso fue descrito en 1853 por Ramsay.…”

“…Si bien, no es clara la etiología se ha postulado como causa la injuria vascular de la arteria pulmonar durante la vida fetal derivando en isquemia y cicatrización bronquial. 1 La localización de la atresia se ha correlacionado con la semana del desarrollo intrauterino en la que se empieza a desarrollar, a saber: 5ª semana lobar, 6ª semana segmentaria y 16ª semana subsegmentaria. 6,7 El bronquio distal al sitio de lesión se desarrollará normalmente y tendrá acceso aéreo a través de vías colaterales como los poros Kohn y canales de Lambert, los cuales permiten mayor flujo de aire durante la inspiración que durante la espiración, resultando en hiperinsuflación y atrapamiento aéreo distal.…”

“…2,6,8 Uno de los métodos para descartar diagnósticos diferenciales es la broncoscopia, que podría permitir la identificación extremo ciego del bronquio atrésico; sin embargo, dependerá que tan distal se localice la atresia. 1 Las broncoscopias realizadas a los casos presentados no identificaron anomalías endobronquiales, siendo reportadas como normales.…”