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Clinical presentation and diagnostic work-up of isolated oesophageal lung in a neonate
  1. Elke Griesmaier1,
  2. Thomas Giner2,
  3. Anna Posod1,
  4. Karin Freund-Unsinn3,
  5. Rudolf Trawöger1,
  6. Ursula Kiechl-Kohlendorfer1
  1. 1Department of Pediatrics II, Innsbruck Medical University, Innsbruck, Austria
  2. 2Department of Pediatrics I, Innsbruck Medical University, Innsbruck, Austria
  3. 3Department of Radiology, Innsbruck Medical University, Innsbruck, Austria
  1. Correspondence to Dr Elke Griesmaier, Department of Pediatrics II, Neonatology, Innsbruck Medical University, Anichstrasse 35, Innsbruck A-6020, Austria; Elke.Griesmaier{at}i-med.ac.at

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A term female baby presented with respiratory distress at the age of 30 min. Chest X-ray revealed suspicion of pneumonia; antibiotic therapy was started (figure 1). On day 7 of life, the infant developed respiratory insufficiency. Chest X-ray showed complete opacification of the right hemithorax with positive air bronchogram. Ultrasonography of the mediastinum showed no vascular sling and bronchoscopy showed no malformation. CT revealed suspicion of high-grade stenosis of the bronchial system. Contrast examination of the oesophagus showed that the main right bronchus was connected to the distal third of the oesophagus (figure 2). The patient was transferred to a specialised surgical centre for tracheobronchial reconstruction.

Figure 1

(A) Chest X-ray at admission showing a generalised reticulogranular pattern and decreased transparency of the right lung, pneumothorax on the left side and mediastinal shift to the right side. (B) Eight hours after admission: generalised reticulogranular pattern of the right lung with improved ventilation and only residual pneumothorax and a normally positioned mediastinum.

Figure 2

Contrast examination showing the main right bronchus stemming from the distal third of the oesophagus.

Communicating bronchopulmonary foregut malformations (CBPFM) encompass a wide spectrum of diseases involving malformations of the respiratory and upper gastrointestinal system.1 ,2 Oesophageal lung is an extremely rare type of CBPFM. In the neonatal period, symptoms may be non-specific and can be the reason for delayed diagnosis. Contrast examination of the oesophagus is the standard diagnostic test to demonstrate the anatomic connections and confirms the diagnosis. Bronchoscopy, CT or MRI are methods used to evaluate anatomical malformations and pulmonary damage, but cannot ratify the diagnosis of isolated CBPFM, especially if pulmonary hypoplasia is absent. In the early neonatal period, bronchial reconstruction is a therapeutic option in patients without signs of parenchymal destruction and normal pulmonary vasculature.3 Highlights of this case are the early clinical presentation and successful diagnostic investigations of isolated oesophageal lung in a neonate.

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Footnotes

  • Contributors All authors contributed to the manuscript.

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.