Case 6

This is a CT pulmonary angiography study.

There is an area of the right lung which demonstrates hyper-inflation or hyper-lucency at the medial segment of the right lower lobe, with a central, tubular branching structure within it which is not communicating with the bronchial or vascular trees.

There are punctate calcifications in the tubular structure. I note that the structure does not enhance on the post contrast images. This most likely represents a bronchocele.

There are some interstitial opacities or focal fibrosis within this hyper-inflated segment of lung, which may reflect post-infectious changes.

The pulmonary arteries show normal opacification; there is no evidence of pulmonary embolism.

These findings are characteristic of bronchial atresia.

The differential diagnosis includes congenital lobar overinflation and Swyer James syndrome- however these cause hyperlucency of an entire lobe of the lung rather than a segment.

Intralobar sequestration is another consideration- however, these typically feature aberrant systemic arterial supply which is absent in this case.

I would convey the findings to the referring physician and recommend discussion at thoracic surgery MDT.