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

A-28-Year-Old-Woman-With-Branching-Opacity-and-Che

Pdf Summary

A 28-year-old woman presented with atypical chest pain and a chronic cough, characterized by pleuritic pain radiating to her right arm. Despite no history of smoking or lung disease, her medical background included recurrent respiratory infections. Initial examinations were unremarkable, with normal vital signs and no distress observed during a physical check-up. However, imaging revealed a significant tubular branching opacity in her right upper lung lobe. A CT scan confirmed a non-enhancing lesion surrounded by hyperlucent areas, suggesting pulmonary abnormalities, but no lymphadenopathy was evident.<br /><br />Further diagnostic tests, including ventilation/perfusion scintigraphy, indicated impaired ventilation and perfusion in the affected lung area. Consequently, she underwent cardiothoracic surgery to remove the problematic lung segment. The surgery disclosed a soft, pliable mass with surrounding hyperexpanded lung tissue, and microscopic analysis confirmed chronic inflammation, dilation, and mucostasis in the airspaces.<br /><br />The diagnosis was bronchial atresia in the right upper lobe, a rare congenital defect where bronchial passage disruptions cause mucus build-up and lung hyperinflation. Though its exact cause is unclear, it is believed to result from developmental issues or vascular insults during fetal growth. Symptoms can include recurrent infections and chest pain, and imaging typically reveals opacities with surrounding hyperlucency.<br /><br />Post-surgery, the patient experienced complete relief from her symptoms. Follow-up imaging showed marked improvement, and she remained symptom-free and active, as evidenced by her participation in the New York City marathon 12 months later. This case illustrates effective diagnostic imaging's role in identifying bronchial atresia, typically treated by resecting the affected lung segment to relieve symptoms and prevent complications.

Keywords

bronchial atresia

chest pain

chronic cough

pulmonary abnormalities

lung hyperinflation

recurrent infections

cardiothoracic surgery

congenital defect

diagnostic imaging

lung resection