CHEST Guidelines-A-28-Year-Old-Woman-With-Branching-Opacity-and-Che (1)

A-28-Year-Old-Woman-With-Branching-Opacity-and-Che (1)

Pdf Summary

A 28-year-old woman presented with atypical chest pain and chronic cough. She reported intermittent pleuritic chest pain radiating to her right arm and had a medical history of recurrent respiratory infections, gastritis, and a previously treated ovarian cyst. Upon examination, she was afebrile and exhibited no acute distress, with normal cardiovascular and respiratory signs, though blood tests revealed mild leukocytosis.<br /><br />Chest imaging through radiographs and a CT scan showed a large tubular branching opacity in her right upper lung lobe, indicating a nonenhancing lesion surrounded by a hyperlucent wedge. A ventilation/perfusion scan confirmed a lack of ventilation and perfusion in the affected lung segment. Surgical intervention was deemed necessary, leading to a posterior segmentectomy of the right upper lobe.<br /><br />Surgical and pathologic evaluations revealed a pliable mass surrounded by hyperexpanded lung tissue. Bronchi proximal to the mass were narrowed, though distal bronchi appeared dilated with mucous stasis. Microscopic examination showed signs of mucostasis, chronic inflammation, and fibrosis.<br /><br />The diagnosis was confirmed as bronchial atresia of the right upper lobe. This condition is characterized by an obstructed bronchus leading to mucus impaction and hyperinflation of distal lung tissue. It generally arises from developmental anomalies and may present with respiratory symptoms or be an incidental radiographic finding.<br /><br />Following surgery, the patient reported complete resolution of her symptoms. Radiographic follow-up demonstrated significant improvement in lung function, and she remained symptom-free a year post-operation, allowing her to partake in vigorous physical activities such as running a marathon. This case highlights the importance of considering bronchial atresia in patients with recurrent pulmonary issues, as well as its distinctive radiologic and pathologic features.

Keywords

bronchial atresia

chest pain

chronic cough

respiratory infections

lung surgery

hyperinflation

mucostasis

pulmonary symptoms

radiologic features

pathologic evaluation