Analysis of imaging in pediatric bronchopulmonary foregut malformations with literature review: case reports

Abstract

Background: Bronchopulmonary foregut malformation (BPFM) is an uncommon condition, with few case reports documented in both national and international literature. This scarcity underscores the importance of utilizing effective imaging techniques to improve our understanding and diagnostic precision concerning this disorder.

Case description: In the first case report, a neonate, born at full term and aged 15 days, presented with symptoms including dyspnea, coughing, wheezing, cyanosis, and vomiting. Initial diagnostic evaluations, which included chest radiography and upper gastrointestinal tract radiography, led to an erroneous initial diagnosis of a left-sided diaphragmatic hernia, accompanied by a suspicion of infection. In the second case report, another neonate, also born at full term but aged 5 days, exhibited symptoms such as coughing, choking, and mild vomiting. Utilizing a combination of computed tomography (CT) scans (plain, enhanced, and reconstructed), chest x-ray, and upper gastrointestinal tract radiography, the diagnosis of BPFM was accurately determined.

Conclusion: Comprehensive imaging examinations play a crucial role in reducing misdiagnosis and diagnostic oversights in cases of BPFM. Given its rarity, BPFM often manifests as a sequestered lung accompanied by gastrointestinal abnormalities. Hence, the integration of CT scans with gastrointestinal tract radiography can substantially improve diagnostic precision in such cases.

Keywords: CT; bronchopulmonary foregut malformation; pediatrics; sequestered lung; upper gastrointestinal tract radiography.

Figure 1

Imaging results for Case 1. (A) A circular clear area in the right cardiophrenic angle and a soft tissue density shadow in the lower left lung. (B,C) The gas-filled cavity in the right cardiophrenic angle, highlighted by a contrast agent, revealing a connection between the stomach and lower esophageal segment to the bronchus in the lesion of the lower left lung demonstrating a branching pattern.

Figure 2

Imaging results for Case 2. (A,B) A soft tissue density shadow in the posterobasal segment of the lower left lung with an internal bronchial gas pattern, where the bronchial shadow within the lesion connects with the esophagus. (C) An abnormal passage between the sequestered lung and the esophagus. (D,E) The sequestered lung and its aberrant supplying artery. (F,G) Faint opacities in the cardiophrenic angle of the lower left lung. The contrast agent in the lower esophagus enters the lesion in the lower left lung through an abnormal passage, displaying a bronchial branching pattern.