January 12, 2022

2019 2nd Place Emage Winner: Bronchial Atresia in an 18‐Month‐Old

An 18-month-old male with no previous medical history presented to the pediatric ED during the summer for 4 months of cough. The parents described the cough as intermittent, lasting weeks at a time, before resolving and then recurring. The cough was associated with intermittent shortness of breath. He had been seen several times in the ED and by his pediatrician and was pending an outpatient ENT workup for intermittent stridor. His parents brought him to the ED because of a choking episode with perioral cyanosis while feeding. The initial CXR below demonstrated a distinct right upper lobe hyperlucency. Working diagnoses included asthma, airway obstruction, and foreign body. Bilateral decubitus xrays were performed, suggesting air trapping. A CT chest was performed that raised concern for bronchial atresia of the right upper lobe.

Patient was admitted with ENT and Pulmonary consultation and a bronchoscopy was performed. Workup confirmed asthma and bronchial atresia. The patient’s bronchi were also therapeutically cleared of copious mucous during bronchoscopy.

Bronchial atresia is an uncommon condition in which a portion of the bronchial tree is underdeveloped. Clinical features of this condition can include recurrent infections, shortness of breath, wheezing, and chest pain. Long term complications of this condition can include feeding difficulties, impaired heart function, and the development of pulmonary hypertension.

Teaching points for this case include:

  1. Recognize hyperlucent or hyperinflated areas of lung on chest X-ray
  2. Be cognizant of a differential diagnosis of congenital lung malformations in young children with recurrent respiratory symptoms.

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Tanya Dall, MD; Tyler Ayalin, MD
Dr. Dall UCI/CHOC ‐ Children’s Hospital of Orange County; Dr. Ayalin ‐ CHOC

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