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A single institution’s experience with the management of peripheral bronchial atresia

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Abstract

Purpose

Peripheral bronchial atresia is a pulmonary abnormality diagnosed on postnatal computed tomography after prenatal imaging reveals a congenital lung lesion. Debate regarding management of this abnormality prompted us to review our institution’s practice patterns and outcomes.

Methods

All patients diagnosed with bronchial atresia were assessed from 6/2014 to 7/2020. Pediatric radiologists were surveyed to delineate computed tomography criteria used to diagnose peripheral bronchial atresia. Criteria were applied in an independent blinded review of postnatal imaging. Data for patients determined to have peripheral bronchial atresia and at least an initial pediatric surgical evaluation were analyzed.

Results

Twenty-eight patients with bronchial atresia received at least an initial pediatric surgical evaluation. Expectant management was planned for 22/28 (79%) patients. Two patients transitioned from an expectant management strategy to an operative strategy for recurrent respiratory infections; final pathology revealed bronchial atresia in both. Six patients were initially managed operatively; final pathology revealed bronchial atresia (n = 3) or congenital lobar overinflation (n = 3).

Conclusions

Peripheral bronchial atresia can be safely managed expectantly. A change in symptoms is suspicious for alternate lung pathology, warranting further workup and consideration for resection.

Level of evidence

Level IV.

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Abbreviations

BA:

Bronchial atresia

CPAM:

Congenital pulmonary airway malformation

CT:

Computed tomography

US:

Ultrasound

BPS:

Bronchopulmonary sequestration

CLO:

Congenital lobar overinflation

MRI:

Magnetic resonance imaging (MRI)

IRB:

Institutional review board

EMERSE:

Electronic medical record search engine

CVR:

Congenital pulmonary airway malformation volume ratio

IQR:

Interquartile range

CXR:

Chest X-ray (CXR)

CCAM:

Congenital cystic adenomatoid malformations (CCAM)

BPS:

Bronchopulmonary sequestration

PPB:

Pleuropulmonary blastoma

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Acknowledgements

We would like to express our sincerest gratitude to the attending pediatric radiology staff at the University of Michigan C.S. Mott Children’s Hospital for their assistance in delineating the radiographic criteria utilized to diagnose peripheral bronchial atresia on CT scan. Without your contribution, this work would not be possible.

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Authors and Affiliations

  1. Division of Pediatric Surgery, Department of Surgery, C.S. Mott Children’s Hospital, University of Michigan, 1540 E. Hospital Dr., Ann Arbor, MI, USA

    Natalie M. Lopyan, Erin E. Perrone, George B. Mychaliska & K. Elizabeth Speck

  2. Fetal Diagnosis and Treatment Center, University of Michigan, Michigan Medicine, Ann Arbor, MI, USA

    Erin E. Perrone & George B. Mychaliska

  3. Division of Pediatric Radiology, Department of Radiology, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA

    Rachel VanHulle & David A. Bloom

Authors
  1. Natalie M. Lopyan
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  2. Erin E. Perrone
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  3. Rachel VanHulle
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  4. David A. Bloom
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  5. George B. Mychaliska
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  6. K. Elizabeth Speck
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Correspondence to Natalie M. Lopyan.

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Lopyan, N.M., Perrone, E.E., VanHulle, R. et al. A single institution’s experience with the management of peripheral bronchial atresia. Pediatr Surg Int 38, 853–860 (2022). https://doi.org/10.1007/s00383-022-05089-z

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  • DOI: https://doi.org/10.1007/s00383-022-05089-z

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