Bronchial Atresia

  • Etiology: Prenatal obliteration of a focal segment of bronchus
  • Imaging:
    — Most commonly in upper lobes
    — Mucoid impaction in bronchus distal to atresia
    — Lung distal to area of atresia is developmentally normal but is hyperinflated and thus hyperlucent due to collateral air drift with air trapping
  • DDX:
  • Complications: May be associated with recurrent infections
  • Treatment:
  • Clinical: Usually asymptomatic

Radiology Cases of Bronchial Atresia

CXR of bronchial atresia
Inspiratory CXR AP (upper left) shows increased lucency in the left upper lobe when compared to the right upper lobe while expiratory CXR AP (upper right) shows air trapping in the left upper lobe. Magnified view of the upper lobes (below) better shows a round lesion in the lower portion of the left upper lobe which represents mucous trapped distally to an area of atresia in a bronchus.
CXR and bronchogram of bronchial atresia of the right middle lobe
CXR AP (above) shows subtle increased lucency of the right middle lobe. AP and oblique images from a vintage bronchogram 3 years later performed by injecting contrast in the right mainstem bronchus (below) shows a hyperlucent and hyperexpanded right middle lobe and contrast filling the airways of the collapsed right upper lobe and the right lower lobe but no contrast filling the airways of the hyperexpanded right middle lobe.

Gross Pathology Cases of Bronchial Atresia

Gross pathological image of bronchial atresia
Gross pathological image of a sectioned right middle lobe shows a dilated mucous filled airway (in white) distal to a focal area of an atretic bronchus.
Pathology image of bronchial atresia
Gross pathological image of a sectioned lung shows an oval dilated mucous filled airway (in the lower right aspect of the specimen) distal to an atretic bronchus.