Esophageal Bronchus

Bronchopulmonary foregut malformations are rare congenital anomalies that are characterized by a fistula between an isolated portion of respiratory tissue and the foregut (Srikanth et al. 1992). Of these malformations, the esophageal bronchus communicating with the lower esophagus is the most common. Com

Fig. 2.14a-d. Esophageal duplication cyst. a AP chest radiograph without appreciable abnormality. b Lateral chest radiograph with anterior bowing and narrowing of the airway above the carina. c Barium esophagram confirms the presence of a soft tissue mass. d Contrast-enhanced CT shows the cyst posterior to the airway, and deforming the airway (arrow)

Fig. 2.14a-d. Esophageal duplication cyst. a AP chest radiograph without appreciable abnormality. b Lateral chest radiograph with anterior bowing and narrowing of the airway above the carina. c Barium esophagram confirms the presence of a soft tissue mass. d Contrast-enhanced CT shows the cyst posterior to the airway, and deforming the airway (arrow)

munication with the stomach is rarer. The abnormal communication develops when the lung sacs come into close contact with the esophagus and a part of the lung bud connects with the esophagus through a focal mesodermal defect. The attached portion of lung tissue, covered by mesenchyme, is carried away by the rapidly elongating esophagus (Srikanth et al. 1992). The arterial supply is variable and may arise from the pulmonary artery or the aorta and its branches. Venous drainage is commonly to the left atrium, but may also be systemic (Leithiser et al. 1985). This malformation is frequently associated with other anomalies. The abnormal connection to the respiratory tract causes respiratory distress, coughing with feeds and recurrent pneumonias.

Treatment is resection of the anomalous pulmonary tissue which is often hypoplastic and destroyed by infection. If detected early enough before pulmonary damage has occurred, tracheal reimplantation is preferred to resection (Michel et al. 1997).

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