1988 Volume 10 Issue 4 Pages 405-410
A 60-year-old man presented with hemoptysis. On the chest X-ray film, the lateral view showed a small area of atelectasis in the left lower lung field. The bronchogram showed a V-shaped complete occlusion at the level of the lower division bronchus (B^<8+9+10>) but the B^6 orifice was patent. Although slightly stenotic. Bronchoscopic biopsy revealed no malignant cells and no mycobacterium tuberculosis were found. We could not establish an definitive preoperative diagnosis. The indications for surgery, left lower lobectomy, in this case were as follows : (1) The site of bleeding was at the inflamed stenotic left B^6 orifice. (2) The inflammation would occur repeatedly. (3) Definitive diagnosis could only be made by pathological examination of the resected specimen. A left thoracotomy was performed which revealed a left lower lobe reduced markedly in fist size. The pathological findings were as follows : 1) Connective tissue surrounding the bronchial cartilage was found at the occluded part of lower division bronchus. 2) The area distal to the stenosis lacked any normal bronchi, bronchioli or alveoli. 3) The basal segments (S^<8+9+10>) of lung showed aplastic changes. The pathological diagnosis was congenital bronchial atresia. This case showed atypical chest X-ray findings and the correct diagnosis was made after postoperative pathological examination.
