A Case Report of Congenital Atresia of the Bronchus Associated with Bronchial Branching Anomaly

Abstract

A 28-year-old man had a chest radiogram showing a band shadow in the right middle field. A CT scan demonstrated a branched structure with distal hyperinflation in the apical segment of the right lower lobe. At bronchoscopic examination there was no identifiable orifice for the right B^6_c bronchus. There was what appeared to be a B^6_a orifice in the truncus intermedius and a B^6_b orifice opposite the B^7 orifice in the right lower lobe bronchus. These orifices were comfirmed by bronchography, at which time the bronchi to S^6_a and S^6_b were filled and visualized, but there was no visualization of B^6_c. The coexistence of bronchial atresia and bronchial branching anomalies, displaced bronchi of B^6_a and B^6_b, in the same segment seems to allow more precise estimate of the time of the development of atresia. That is to say, the presence of bronchial anomalies in the same segmet led to the hypothesis that atresia occured during the 5th or 6th weeks of intrauterine life when the central airways are formed. We have also reviewed 43 cases previously reported in Japan to more clearly define this unusual entity.