CHEST Guidelines-A-28-Year-Old-Woman-With-Branching-Opacity-and-Che (2)

A-28-Year-Old-Woman-With-Branching-Opacity-and-Che (2)

Pdf Summary

A 28-year-old woman presented with atypical chest pain and chronic cough. Her medical history included recurrent respiratory infections, gastritis, and a left ovarian cyst surgery. Examination revealed no acute distress, and her vital signs were stable. Initial tests included normal blood chemistry but showed leukocytosis. Chest radiographs revealed a large branching opacity in the right upper lobe, confirmed as nonenhancing on a contrast-enhanced CT scan, and surrounded by hyperlucency. Additionally, a ventilation/perfusion scan indicated limited function in the affected area.<br /><br />The patient was diagnosed with bronchial atresia, a rare congenital defect characterized by interruption of a bronchial segment, typically resulting in mucus impaction and hyperinflation of distal lung tissue. The diagnosis is supported by radiographic signs, especially the branching opacity aiming towards the hilum and surrounding hyperlucency. Most cases are incidentally discovered but can cause symptoms like recurrent infections, atypical chest pain, or dyspnea.<br /><br />Surgical intervention involved a posterior segmentectomy of the right upper lobe. Pathological examination showed a pliable mass representing a mucocele surrounded by hyperexpanded lung parenchyma. Histologically, dilated air spaces, mucostasis, and chronic inflammation were noted. Postoperatively, the patient experienced complete resolution of symptoms and no complications or recurrence were observed over a 12-month follow-up.<br /><br />Bronchial atresia can often be managed conservatively, particularly in asymptomatic cases or when radiological findings are incidentally noted. However, surgical resection may be warranted in cases involving significant symptoms or recurrent pulmonary infections, leading to symptomatic relief and improved lung function.

Keywords

bronchial atresia

chest pain

chronic cough

respiratory infections

leukocytosis

branching opacity

hyperlucency

mucocele

posterior segmentectomy

lung function