Cases on airways for radiology residents

74. • An otherwise-healthy 30-year-old man with no significant past medical history
presented with a 2-day history of worsening dyspnea.
• He was working in a corn silo the morning before which was filled with nitrous
dioxide
• He inhaled some of the gas and developed dyspnea later that day.
• The symptoms increased in severity, and the patient subsequently required
mechanical ventilation.

78. • Laboratory blood work revealed a white blood cell count of
23,100/mm3 with 95% neutrophils.
• Computed tomography of the thorax without contrast showed severe
diffuse alveolitis and inflammatory nodules, consistent with acute
hypersensitivity pneumonitis and inhalational pulmonary injury.
• Portable chest radiography showed bilateral multi-lobular nodular
opacities.
• The patient was successfully treated with furosemide and high dose
prednisone, and his respiratory symptoms improved dramatically.
• Serial portable chest radiography demonstrated radiographic
improvement consistent with the patient’s clinical improvement.

79. • He was successfully extubated after one day on mechanical
ventilation and weaned from supplemental oxygenation the
following day.
• He was discharged home with oral prednisone and is
scheduled for a follow-up appointment.

84. What is this sign?

96. Differential Dx

112. History:
42-yr-old asymptomatic women.
Preoperative chest plain film.
Case of the Month 12
June 2016

113. Case of the Month 12

114. Case of the Month 12

115. Case of the Month 12
What is your diagnosis ?

116.  Parahilar tubular opacity in the right
upper lobe.
Case of the Month 12

117.  A hyperlucent area surrounding the tubular opacity, with hyperinflation
(notice widening of the right intercostal spaces)
Case of the Month 12

118.  Branching parahilar tubular opacity in the
right upper lobe
 Hyperlucent area surrounding the branching
tubular opacity
 In the mediastinal window the tubular opacity
has low attenuation
Case of the Month 12

119. Case of the Month 12
 Coronal view showing the branching parahilar tubular opacity in
the right upper lobe
 Hyperlucent area surrounding the branching tubular opacity

120. Case of the Month 12
Diagnosis
Congenital Bronchial Atresia
Differential Diagnosis
Congenital Lobar Emphysema
Airway obstruction caused by:
foreign body
tumour
inflammation
Case provided by Eva Castaner, Sabadell Spain

121. Case of the Month 12
Discussion
 Rare congenital anomaly, characterized by short-segment
obliteration of a lobar, segmental or subsegmental bronchi
at or near its origin. This results in accumulation of mucus
distal to the atresia.
 Air can enter the affected segment via collateral channels
showing features of air trapping and overinflation
 Most common location, the apicoposterior segment of the
left upper lobe (50%) followed by the right upper lobe
(20%).
 The majority of patients are asymptomatic; some have
recurrent pneumonia
 Bronchoscopy may be required to rule out other causes of
obstruction (tumours, foreign bodies or inflammatory strictures)
 Seldom associated with significant complications; rarely
requires surgical resection.

122. Case of the Month 12
Discussion
CHEST RADIOGRAPHY
 Tubular opacity
 Hyperlucent area, air trapping
CT
 Tubular/branching opacity (mucocele, bronchocele)
 Low attenuation hyperinflated lung
 Hypoperfusion of the affected segment

123. Case of the Month 12
Further Reading
CONGENITAL BRONCHIAL ATRESIA
1) Gipson MG et al.Bronchial atresia. Radiographics 2009 ;29(5):1531–5
2) Wang Y et al. Congenital bronchial atresia: diagnosis and treatment. Int J Med Sci 2012;
9(3):207–12
3) Ghaye B et al. Congenital bronchial abnormalities revisited. Radiographics 2001;21:105-19.
4) Matsushima H et al. Congenital Bronchial atresia: radiologic findings in nine patients. J
Comput Assist Tomogr 2002; 26: 860-864.

124. References
• http://www.myesti.org/