CONGENITAL BRONCHIAL ATRESIA: A RARE ENTITY

Abstract

SESSION TITLE: Tuesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Congenital Bronchial Atresia (CBA) is a rare developmental anomaly, results from focal interruption of bronchus along with the formation of mucocele (mucus filled bronchus). It often presents in adulthood, as an incidental finding on radiography or recurrent pneumonia. Computed tomography (CT) angiogram of the chest remains the investigation of choice in the diagnosis of CBA while bronchoscopy should be done to rule out other etiologies of hyperinflation. Management of CBA is conservative for asymptomatic individuals while surgery is reserved for individuals who have the recurrent infection and severe symptoms. CASE PRESENTATION: 19-year-old male with no known past medical history presented to the ED for evaluation of dry cough and subjective fever for 5 days. Patient denied any shortness of breath, hemoptysis, chest pain, night sweats, weight loss or change in appetite. Patient was not taking any medication at home. Past surgical and family history was not significant. Patient denied smoking, alcohol use and any illicit drug abuse. On admission, he was afebrile, hemodynamically stable and saturating 99% on room air. In terms of labs, white cell count was elevated initially and then trended down; rest of the labs including molecular flu, pro-calcitonin, legionella antigen, mycoplasma antigen, respiratory syncytial virus PCR and blood culture were negative. Chest x-ray showed hyperlucency and decreased vascularity in the left upper lung zone along with consolidation in the left lower lobe. Patient was started on antibiotics and treated for community-acquired pneumonia. CT angiogram of the chest (1) showed round soft tissue density suggestive of mucoid impaction of the left bronchus likely mucocele along with hyperlucent left upper lobe and hypoplastic vasculature consistent with bronchial atresia (Figure 1 and 2). Bronchoscopy was normal which was done to rule out other etiologies like foreign body, bronchial adenoma, and lung cancer. V/Q scan showed no ventilation and perfusion to the majority of left upper lobe (figure 3). Patient showed signs of clinical improvement and discharged on oral antibiotics with outpatient follow up. DISCUSSION: CBA is a benign and rare entity with characteristic imaging finding resembling other serious underlying disease. Management can range from conservative measure to the surgery of an involved segment of the lung. Therefore, it is imperative to understand the nature of the disease and counsel the patient accordingly. CONCLUSIONS: Although benign entity, CBA should be kept in the differential especially in young patients who present with hyperinflation of one or more segment of lung which might cause compression atelectasis and/or pneumonia of the other adjacent segments as it presented in our case. CTA of the chest is usually the modality to diagnose with bronchoscopy and V/Q scan to guide further management. Reference #1: Psathakis K, Eleftheriou D, Boulas P, Mermigkis C, Tsintiris K. Congenital bronchial atresia presenting as a cavitary lesion on chest radiography: a case report. Cases J. 2009;2(1):17. Published 2009 Jan 7. https://doi.org/10.1186/1757-1626-2-17 Reference #2: Mahajan AK, Rahimi R, Vanderlaan P, Folch E, Gangadharan S, et al. (2017) Unique Approach to Diagnosing and Treating Congenital Bronchial Atresia (CBA): A Case Series. J Pulm Respir Med 7:402. https://doi.org/10.4172/2161-105X.1000402 DISCLOSURES: No relevant relationships by Anas Al-khateeb, source=Web Response No relevant relationships by mohammed halabiya, source=Web Response No relevant relationships by Muhammad Hussain, source=Web Response No relevant relationships by Muqueet Kadri, source=Web Response No relevant relationships by Richard Miller, source=Web Response No relevant relationships by Hari Sharma, source=Web Response