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Computed tomography and upper gastrointestinal series findings of esophageal bronchi in infants

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Abstract

Background

Esophageal bronchus is a rare form of communicating bronchopulmonary foregut malformation and a rare but important cause of an opaque hemithorax on chest radiography. A higher incidence of esophageal bronchus is associated with esophageal atresia, tracheo-esophageal fistula (TEF) and VACTERL (vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities) association. In the presence of these conditions, the pediatric radiologist may be the first to consider the diagnosis of esophageal bronchus or esophageal lung.

Objective

To describe the imaging features in five children with esophageal bronchus.

Materials and methods

We reviewed hospital records and teaching files at two large pediatric tertiary referral centers over the 24-year period from January 1992 to January 2016. We reviewed all imaging studies and tabulated findings on radiography, fluoroscopic upper gastrointestinal (GI) series and CT. We then described the imaging features of esophageal bronchi with emphasis on CT and upper GI findings in four infants and one toddler.

Results

Three cases were identified from one institution (cases 2, 3, 4) and two from another (cases 1, 5). All five cases occurred in association with other midline malformations: four of the five had VACTERL association and three of the five had esophageal atresia and TEF.

Conclusion

Lung opacification, ipsilateral mediastinal shift, and an abnormal carina and anomalous vascular anatomy suggest an esophageal bronchus or an esophageal lung on CT. While esophageal bronchus is a rare cause of an opaque hemithorax, CT and upper GI imaging play key roles in its diagnosis. Associations with esophageal atresia with tracheo-esophageal fistula and VACTERL association are particularly pertinent. Early diagnosis of esophageal bronchus might prevent complications such as aspiration and infection, which can allow for parenchymal sparing surgery as opposed to pneumonectomy.

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Acknowledgments

We thank Dr. Micheal McDermott and Dr. Tom Milligan for pathology support and Mr. Ethan Bremner and Mr. Ross Cullen for graphics assistance.

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Authors and Affiliations

  1. Department of Radiology, Boston Children’s Hospital and Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA

    Gabrielle C. Colleran & Edward Y. Lee

  2. Department of Radiology, Our Lady’s Children’s Hospital Crumlin, Dublin, Ireland

    Gabrielle C. Colleran, David Rea & Clare Brenner

  3. Department of Pathology, Our Lady’s Children’s Hospital Crumlin, Dublin, Ireland

    Ciara E. Ryan

  4. Department of Surgery, Our Lady’s Children’s Hospital Crumlin, Dublin, Ireland

    Brian Sweeney

Authors
  1. Gabrielle C. Colleran
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  2. Ciara E. Ryan
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  3. Edward Y. Lee
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  4. Brian Sweeney
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  5. David Rea
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  6. Clare Brenner
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Correspondence to Gabrielle C. Colleran.

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Colleran, G.C., Ryan, C.E., Lee, E.Y. et al. Computed tomography and upper gastrointestinal series findings of esophageal bronchi in infants. Pediatr Radiol 47, 154–160 (2017). https://doi.org/10.1007/s00247-016-3724-6

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  • DOI: https://doi.org/10.1007/s00247-016-3724-6

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