Connected to the wrong pipe: esophageal bronchi mimicking bilateral bronchial atresia

ABSTRACT
Infants frequently present with respiratory symptoms, but diagnosing the underlying pulmonary condition is sometimes challenging.
A 2-week-old neonate was referred to a postnatal history of tachypnea, poor feeding and elevated plasma inflammation markers. The patient was presented with mild episodes of coughing after feeding and diminished breath sounds of the right upper lung. A chest radiograph revealed bilateral consolidations. Whereas bronchoscopy was suggestive of bilateral bronchial atresia, computed tomography supported bronchial atresia of the right upper and middle lobe and a left-sided broncho-esophageal communication. Surprisingly, an upper gastrointestinal series revealed bilateral esophageal insertion of bronchi, and the diagnosis of a communicating bronchopulmonary foregut malformation (CBPFM) was made. Two-stage lobectomy of the affected lobes and segments was performed on days 31 and 41 after birth. Histopathological examination exhibited hamartomatous lung tissue with purulent bronchopneumonia. At a follow-up examination after 4 years, the patient was asymptomatic and thriving well with oral feeds.
CBPFM are rare malformations. This case highlights the clinical challenge of diagnosing this rare condition. There is a need to raise awareness for such uncommon conditions and improve diagnostic accuracy. For optimal management a multidisciplinary approach is essential.

IMPACT STATEMENT
This manuscript presents a complex case of a neonate referring to a postnatal history of tachypnea, poor feeding, and elevated plasma inflammatory markers. While initial diagnostics suggested bronchial atresia, further evaluation led to the diagnosis of a communicating bronchopulmonary foregut malformation. This case highlights the diagnostic challenges associated with rare neonatal conditions, emphasizing the need for increased awareness and improved diagnostic accuracy. Optimal management requires a multidisciplinary approach to ensure comprehensive care.

Received: June 21, 2024
Accepted: Aug 26, 2024
Published: Mar 10, 2025