Gabrielle C Colleran1,2, Ciara E Ryan3, Edward Y Lee4, Brian Sweeney5, David Rea6, Clare Brenner6. 1. Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA. gabrielle.colleran@childrens.harvard.edu. 2. Department of Radiology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland. gabrielle.colleran@childrens.harvard.edu. 3. Department of Pathology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland. 4. Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA. 5. Department of Surgery, Our Lady's Children's Hospital Crumlin, Dublin, Ireland. 6. Department of Radiology, Our Lady's Children's Hospital Crumlin, Dublin, Ireland.
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.
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.
Authors: Emily A Partridge; Teresa Victoria; Beverly G Coleman; Juan Martinez-Poyer; Pablo Laje; Holly L Hedrick; Alan W Flake; N Scott Adzick Journal: J Pediatr Surg Date: 2014-11-10 Impact factor: 2.545
Authors: Niamh C Adams; Teresa Victoria; Edward R Oliver; Julie S Moldenhauer; N Scott Adzick; Gabrielle C Colleran Journal: Pediatr Radiol Date: 2020-11-30
Authors: Brent P Little; Dexter P Mendoza; Andrew Fox; Carol C Wu; Jeanne B Ackman; Jo-Anne Shepard; Ashok Muniappan; Subba R Digumarthy Journal: J Thorac Dis Date: 2020-06 Impact factor: 2.895
Authors: Stephen L Trisno; Nara S Higano; Dan Kechele; Talia Nasr; Wendy Chung; Aaron M Zorn; Jason C Woods; James M Wells; Paul S Kingma Journal: Front Pediatr Date: 2021-07-09 Impact factor: 3.418
Authors: Enrique Villamizar; Maria Daniela Moreno Villamizar; Mauricio Pedraza Ciro; Jean Pulido; Maria Rodriguez; Juan Carlos Villamizar Journal: European J Pediatr Surg Rep Date: 2019-11-28