2024 Friday Quiz 17 Answer | Figure 1

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2024 Friday Quiz 17 Answer

Axial (Image 1), coronal (Image 2), and axial minimum intensity projection (Image 3) scans exhibit multiple features consistent with bronchial atresia: a branching tubular opacity (arrow) signifies the affected bronchus, accompanied by a simplified, hyperlucent lung (arrowhead). Bronchial atresia typically originates from a proximal bronchial segment's focal obliteration. Imaging often reveals a branching tubular opacity emanating from the hilum, with the distal lung appearing hyperlucent. It is most commonly seen in the left upper lobe, followed by the right upper, middle, and lower lobes. Scimitar syndrome may resemble bronchial atresia; however, it differs in the tubular density's path, arising medially at the chest base and extending laterally, unlike bronchial atresia's origin from the hilum.

Similar cases

Axial inspiratory (image 1) and expiratory (image 2) CT images of the chest show ground-glass opacity affecting the right middle lobe and lingula characteristic of neuroendocrine cell hyperplasia of infancy (NEHI). There is relative hyperinflation of the lower lobes. NEHI is a rare childhood interstitial lung disease that most commonly occurs in the first year of life. Diagnosis is often made due to the characteristic imaging findings.](https://app.figure1.com/case-detail/09a9164d-0b73-4e0a-b80f-49b49a0ec279)

Chest radiograph (image 1) shows a relatively small, lucent left hemithorax with a normal appearance of the right lung. Axial (image 2) and coronal (image 3) CT images show simplification of the small left lung with fewer vascular structures. Atelectasis is present in the left upper lobe. The imaging findings are seen typical of Swyer-James syndrome, a post infectious obliterative bronchiolitis. Swyer-James syndrome is characterized by a hyperlucent small lung.](https://app.figure1.com/case-detail/0b0678b5-ac0b-4beb-a22e-b8bd5626a78b)

CT of the chest shows a dilated, fluid-filled right lower lobe bronchus (arrow). The lung distal to this is hyperinflated. Bronchial atresia is most common in the left upper lobe and least common in the right lower lobe. On x-ray, the impacted bronchus has a "finger-in-glove" appearance. #ThoraxThursday](https://app.figure1.com/case-detail/17d2e796-36c0-4046-b73e-6d1377e33706)

Coronal chest CT scan demonstrates left upper lobe hyperinflation (arrow) with distinct demarcation at the major fissure (arrowhead), indicative of congenital lobar overinflation. Differential diagnosis considerations for such a finding include bronchial atresia, congenital pulmonary airway malformation, and pleuropulmonary blastoma. Congenital lobar overinflation predominantly affects the left upper lobe. While the presentation might resemble bronchial atresia, the absence of an opacified bronchus aids in distinguishing between the two conditions.](https://app.figure1.com/case-detail/6c27cd84-0572-45e3-a66e-e81c442c8b36)