Incidentally Detected Congenital Bronchial Atresia in Late Adulthood: A Case Report and Imaging Review.

Bronchial atresia is a rare congenital anomaly characterized by focal interruption of a bronchus, typically associated with distal mucoid impaction and hyperinflation of the corresponding lung parenchyma. It is usually identified incidentally in children or young adults, whereas diagnosis in late adulthood is uncommon. We report the case of a 59-year-old man who presented with chronic cough and dyspnea. Chest computed tomography (CT), performed before and after intravenous contrast administration, revealed focal unilateral hyperlucency involving the posterior segment of the right upper lobe, associated with a moniliform bronchocele containing mucoid impaction and interruption of the proximal continuity of a dorsal subsegmental bronchus with the segmental bronchus and the central tracheobronchial tree. No enhancing endobronchial lesion, suspicious pulmonary mass, post-obstructive consolidation, or significant lymphadenopathy was identified. These findings were highly suggestive of congenital bronchial atresia. The patient was referred for pulmonology evaluation. In the absence of superinfection, significant functional impairment, or persistent diagnostic uncertainty, conservative management with clinical follow-up was recommended. The patient remained clinically stable during five months of follow-up, with no worsening of symptoms or recurrent respiratory infection. This case highlights the key role of CT in establishing the diagnosis of bronchial atresia in adulthood and in differentiating it from other causes of focal hyperlucency and bronchial obstruction.