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TITLE : Esophageal lung complicated by recurrent pneumonia
TEXT : 6 month old child presented with complaints of recurrent
respiratory infection, tachypnea and decreased air entry on right side .
Xray chest AP view (Fig1) showed opaque right hemithorax with
ipsilateral mediastinal shift and compensatory hyperinflation of left
lung. Further evaluation with CECT thorax (Fig 2) showed hypoplastic
right lung with collapse consolidation and right sided mediastinal
shift. Bifurcation of trachea was not seen with trachea continuing as
left main bronchus with normal segmental division. Right bronchus
appears to be arising from lower part of esophagus, precise
communication was not demonstrated (Fig 3). Conventional contrast (non
ionic) esophagogram was performed and free flow of contrast was seen
from lower third of esophagus to the right main bronchus (Fig 4)
confirming the diagnosis of Congenital bronchopulmonary foregut
malformation (CBPFM) 1. CBPFM consist of fistulous communication between
respiratory and gastrointestinal tract and are more common in female
child which usually present as recurrent episodes of choking while
feeding, respiratory infection or failure depending upon type of
malformation 2 with opacification and consolidation of involved lung is
seen on imaging 3. It is classified by Srikanth et al1into 4 major types. Type 1A Total sequestered lung communicating with
the foregut, associated with esophageal atresia and tracheoesophageal
fistula to the distal pouch Type 1B: Sequestered anatomic lobe or
segment communicating with the foregut, associated with esophageal
atresia and tracheoesophageal fistula to the distal pouch, Type II:
Total sequestered lung communicating with the lower esophagus; absent
ipsilateral mainstem bronchus, Type III: Isolated anatomic lobe or
segment communicating with the foregut and Type IV: Portion of the
normal bronchial system communicating with the esophagus. Our case comes
under category II in which right main bronchus is seen arising from
distal esophagus. More commonly anomalous origin of right main bronchus
is seen due to its proximity with esophagus4.
References
- Srikanth MS, Ford EG, Stanley P, Mahour GH. Communicating
bronchopulmonary foregut malformations: Classification and
embryogenesis. J Pediatr Surg. 1992;27: 732-6.
- Verma A, Mohan S, Kathuria M, Baijal SS. Esophageal bronchus: Case
report and review of the literature. Acta
Radiol. 2008;49:138–41.
- ) Bokka S, Jaiswal A, Behera B, Mohanty M, Khare M, Garg A. Esophageal
lung: a rare type of communicating bronchopulmonary foregut
malformation, case report with review of literature. J Indian
Assoc Pediatr Surg. (2015) 20:92. doi: 10.4103/0971-9261.151558
- Sur A, Sardar SK, Paria A. Left sided esophageal lung: A Diagnostic
challenge. Case Rep Pediatr 2013. 2013:947401.