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Bronchial Atresia

81

 

 

a

b

c

Fig. 10.5 Allergic bronchopulmonary aspergillosis in a 56-year-old asthmatic woman. (a) Mediastinal window of unenhanced CT scan (2.5-mm section thickness) obtained at level of the right middle lobar bronchus shows high-attenuation V-shaped branching structures (arrows) in lingular division of the left upper lobe. (b) Bronchoscopy

Table 10.1 Common diseases manifesting as gloved Þnger sign

Disease

Key points for differential diagnosis

Benign and malignant

 

neoplasms causing

 

airway obstruction

 

Bronchial atresia

Bronchocele in the apicoposterior

 

segment of the left upper lobe

Broncholithiasis

Endobronchial or peribronchial location

 

of calciÞed lymph nodes

Bronchial tuberculosis

Aneurysmal appearance of

 

medium-sized bronchi

Foreign-body aspiration

Intrabronchial foreign body with gloved

 

Þnger sign

ABPA

Central bronchiectasis with high-

 

attenuation mucus plugging

Note: ABPA allergic bronchopulmonary aspergillosis

depicts yellow mucus (arrows) obstructing lingular divisional bronchus. (c) Low magniÞcation (×8) photomicrograph obtained with bronchoscopic biopsy discloses allergic mucin (mucus plus eosinophils) (arrows) containing calciÞcations

CT–Pathology Comparisons

Pathologically, the bronchial tree peripheral to the point of obliteration is patent and has a normal number of airways and airspaces. This results in the accumulation of mucus and an attendant mucocele immediately distal to the atresia. The alveoli in the lung supplied by the atretic bronchus are ventilated by collateral pathways and show features of air trapping with hyperinßation.

Patient Prognosis

Treatment is usually conservative. Surgery is only indicated when major clinical symptoms are present.