Embryology of Bronchial Atresia

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We were interested by the report by Williams and Schuster on the association of bronchial atresia and bronchogenic cyst (Chest 1985; 87:396–98). We are aware of two similar cases in previous publications. Case 2 of Tsuji et al1Tsuji S Held S Sato A The syndrome of bronchial mucocele and regional hyperinflation of the lung.Chest. 1973; 64 (44–447)Crossref Scopus (13) Google Scholar showed bronchial mucocele and hyperinflation of the right upper lobe, together with a mediastinal bronchogenic cyst. Case 2 of Brocard and Gallouedec2Brocard H Gallouedec Ch Les formes radiocliniques de l'atrésie bronchique.Rev Fr Mal Respir. 1976; 4 (953–62)Google Scholar had bronchial atresia and mucocele of the posterior segmental bronchus of the left lower lobe and a bronchogenic cyst in paraesophageal position, as was confirmed pathologically. Other congenital anomalies have been associated with bronchial atresia: pericardial defect,3Montaque NT Shaw RR Bronchial atresia.Ann Thorac Surg. 1974; 18 (337–45)Google Scholar, 4Jones P Developmental defects in the lungs.Thorax. 1955; 10 (205–13)Crossref Scopus (11) Google Scholar atrium septum defect and left-sided inferior vena cava,5Medelli J Lattaignant JC Bertoux JP Pietri J Gaudot B Remond A L'atrésie bronchique segmentaire.Poumon. 1979; 35: 53-58Google Scholar congenital cystic adenomatoid malformation (CCAM) Stocker type III,6Cacia R Sobonya RE Congenital cystic adenomatoid malformation of the lung with bronchial atresia.Hum Pathol. 1981; 12 (947–50)Google Scholar unilateral agenesis of the kidney,7Vaghei R Bronchial atresia of upper lobe of the lung.Chest. 1970; 57: 91-94Crossref PubMed Scopus (5) Google Scholar anomalous venous drainage of the left upper lobe,8Desvignes C Hummel J Jamet G Levasseur P Rojas-Miranda A Verley J et al.Emphysème pulmonaire et atrésie bronchique.Ann Chir Thorac Cardiovasc. 1974; 13 (135–38)Google Scholar pulmonary sequestration,3Montaque NT Shaw RR Bronchial atresia.Ann Thorac Surg. 1974; 18 (337–45)Google Scholar and fusion of apophyseal joints C2-C3.8Desvignes C Hummel J Jamet G Levasseur P Rojas-Miranda A Verley J et al.Emphysème pulmonaire et atrésie bronchique.Ann Chir Thorac Cardiovasc. 1974; 13 (135–38)Google Scholar These associated defects occur early in embryologic development; eg, the pericardium is normally formed in the fifth week9Hudson REB Diseases of the pericardium.in: Hurst JW The heart. McGraw Hill, New York1978Google Scholar and the interatrial septum is normally complete in the eighth week.10De Haan RL O'Rahiely R Embryology of the heart.in: Hurst JW The heart. McGraw Hill, New York1978: 6-18Google Scholar CCAM Stocker type III is believed to result from an injury at the time of early budding of the lung.11Stocker JT Drake RM Madewell JE Cystic and congenital lung disease in the newborn.Perspect Pediatr Pathol. 1978; 4 (93–154)Google Scholar Renal agenesis occurs prior to 31 days.11Stocker JT Drake RM Madewell JE Cystic and congenital lung disease in the newborn.Perspect Pediatr Pathol. 1978; 4 (93–154)Google Scholar These associations indeed point towards the early phases of budding of the lung (fourth to sixth week) as the origin of bronchial atresia, at least for a number of cases.